Provider Demographics
NPI:1154700979
Name:AMERICAN MEDICAL DISTRIBUTORS
Entity type:Organization
Organization Name:AMERICAN MEDICAL DISTRIBUTORS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-775-6666
Mailing Address - Street 1:PO BOX 36787
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-0787
Mailing Address - Country:US
Mailing Address - Phone:586-775-6666
Mailing Address - Fax:
Practice Address - Street 1:24912 HARPER AVE
Practice Address - Street 2:2
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1242
Practice Address - Country:US
Practice Address - Phone:586-775-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health