Provider Demographics
NPI:1356223978
Name:MODERN MEDICAL SERVICE INC
Entity type:Organization
Organization Name:MODERN MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOIDERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-627-9949
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-0345
Mailing Address - Country:US
Mailing Address - Phone:231-627-9949
Mailing Address - Fax:231-627-8294
Practice Address - Street 1:127 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1637
Practice Address - Country:US
Practice Address - Phone:231-627-9949
Practice Address - Fax:231-627-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy