MEDICARE: AMERICAN DURABLE MEDICAL EQUIPMENT AND SUPPLIES LLC

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		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540E017240	OTHER	MI	BLUE CARE NETWORK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4834100001	OTHER	MI	ABP ADMINISTRATION
4	540H21560	OTHER	MI	BCBS-MI FED EMPLOYEE PROG

General Provider Information

NPI Number	:	1326106030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DURABLE MEDICAL EQUIPMENT AND SUPPLIES LLC

Provider Business Mailing Address
First Line	:	21901 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2217
Country	:	US
Telephone Number	:	586-863-1840
Fax Number	:	586-863-1841

Provider Business Practice Location Address
First Line	:	21901 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2217
Country	:	US
Telephone Number	:	586-863-1840
Fax Number	:	586-863-1841

Authorized Official
Title or Position	:	PRESIDENT/CHIEF EXECUTIVE OFFICER
Name	:	MFON OWOROETOP
Credential	:
Telephone Number	:	15868631840

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/25/2012

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