MEDICARE: PHOENIX MEDICAL SUPPLY, INC.

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	332BX2000X	Oxygen Equipment & Supplies (DME)	06819C	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	540F301900	OTHER	MI	BLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number	:	1881623627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	23370 COMMERCE DR STE 2
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-2726
Country	:	US
Telephone Number	:	248-354-5200
Fax Number	:	248-354-9638

Provider Business Practice Location Address
First Line	:	23370 COMMERCE DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-2726
Country	:	US
Telephone Number	:	248-354-5200
Fax Number	:	248-354-9638

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LILLIE M NORRIS
Credential	:
Telephone Number	:	248-354-5200

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	11/20/2024

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