=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760768303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDEMPTION MEDICAL SUPPLY &EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2011
-----------------------------------------------------
Last Update Date | 10/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1319 N SAGINAW ST
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-1739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-406-9832
-----------------------------------------------------
Fax | 810-767-9460
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1319 N SAGINAW ST
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-1739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-406-9832
-----------------------------------------------------
Fax | 810-767-9460
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NATHAN GREGORY
-----------------------------------------------------
Credential | SUPPLY
-----------------------------------------------------
Telephone | 407-406-9832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------