MEDICARE: INTERNATIONAL MEDICAL SUPPLY COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1134593460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL MEDICAL SUPPLY COMPANY

Provider Business Mailing Address
First Line	:	547 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	547 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:	313-961-1000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BENJAMIN WHITFIELD JR.
Credential	:
Telephone Number	:	313-961-1000

Provider Enumeration Date	:	11/24/2015
Last Update Date	:	11/24/2015

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