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General NPI Number Information
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NPI Number | 1811386717
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Entity Type | Organization
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Legal Business Name | PLAGENS MEDICAL SUPPLY CONSULTANTS
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 48679 ALPHA DR SUITE 100
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City | WIXOM
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State | MI
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Zip | 48393-3455
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Country | US
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Telephone | 517-586-6000
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Fax | 517-586-6001
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Provider Business Mailing Address
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Address Line | 48679 ALPHA DR SUITE 100
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City | WIXOM
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State | MI
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Zip | 48393-3455
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SHAREHOLDER/PARTNER
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Name | MR. JASON T. WALTERS
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Credential |
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Telephone | 517-398-0425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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