Provider Demographics
NPI:1063712792
Name:DESTINATION MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:DESTINATION MEDICAL EQUIPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-242-6744
Mailing Address - Street 1:5314 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1611
Mailing Address - Country:US
Mailing Address - Phone:586-242-6744
Mailing Address - Fax:
Practice Address - Street 1:5314 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-1611
Practice Address - Country:US
Practice Address - Phone:248-623-0497
Practice Address - Fax:248-623-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies