Provider Demographics
NPI:1063421402
Name:FOSTER FAMILY MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:FOSTER FAMILY MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-837-0071
Mailing Address - Street 1:PO BOX 19244
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-837-0071
Mailing Address - Fax:313-837-3323
Practice Address - Street 1:20101 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-837-0071
Practice Address - Fax:313-837-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4220450Medicaid
MI540H21765OtherBCBS DME NUMBER
MI540H21765OtherBCBS DME NUMBER