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General NPI Number Information
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NPI Number | 1881623627
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Entity Type | Organization
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Legal Business Name | PHOENIX MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 23370 COMMERCE DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-2726
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Country | US
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Telephone | 248-354-5200
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Fax | 248-354-9638
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Provider Business Mailing Address
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Address Line | 23370 COMMERCE DR STE 2
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-2726
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Country | US
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Telephone | 248-354-5200
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Fax | 248-354-9638
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Authorized Official
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Title or Position | OWNER
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Name | MS. LILLIE M NORRIS
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Credential |
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Telephone | 248-354-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 06819C
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License Number State | MI
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