Provider Demographics
NPI:1063772192
Name:MEDICAL ENTERPRISES INC
Entity type:Organization
Organization Name:MEDICAL ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-553-5691
Mailing Address - Street 1:4970 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MI
Mailing Address - Zip Code:48731-5155
Mailing Address - Country:US
Mailing Address - Phone:989-375-2121
Mailing Address - Fax:989-375-2124
Practice Address - Street 1:4970 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MI
Practice Address - Zip Code:48731-5155
Practice Address - Country:US
Practice Address - Phone:989-375-2121
Practice Address - Fax:989-375-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010098163336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1063772192Medicaid
2135173OtherPK
MI1063772192Medicaid