Provider Demographics
NPI:1306249677
Name:TOTAL KNEE ACCELERATED RECOVERY DME, LLC
Entity type:Organization
Organization Name:TOTAL KNEE ACCELERATED RECOVERY DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-550-0497
Mailing Address - Street 1:21238 BRIDGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4089
Mailing Address - Country:US
Mailing Address - Phone:248-550-0497
Mailing Address - Fax:614-300-1420
Practice Address - Street 1:21238 BRIDGE ST STE B
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4089
Practice Address - Country:US
Practice Address - Phone:248-550-0497
Practice Address - Fax:614-300-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies