Provider Demographics
NPI:1073359006
Name:MOVEMENT ORTHOPEDIC DME
Entity type:Organization
Organization Name:MOVEMENT ORTHOPEDIC DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-242-5832
Mailing Address - Street 1:4488 CHARING CROSS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3110
Mailing Address - Country:US
Mailing Address - Phone:586-242-5832
Mailing Address - Fax:
Practice Address - Street 1:43475 DALCOMA DR STE 250
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3594
Practice Address - Country:US
Practice Address - Phone:586-436-3785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies