Provider Demographics
NPI:1407837636
Name:MASTERS MEDICAL SUPPLY
Entity type:Organization
Organization Name:MASTERS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIKKINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-548-3800
Mailing Address - Street 1:6480 GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7305
Mailing Address - Country:US
Mailing Address - Phone:517-548-3800
Mailing Address - Fax:517-548-3808
Practice Address - Street 1:6480 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7305
Practice Address - Country:US
Practice Address - Phone:517-548-3800
Practice Address - Fax:517-548-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME-0155030332B00000X
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540D703090OtherBCBS
MI4365823Medicaid
MI4365823Medicaid