Provider Demographics
NPI:1992886600
Name:BALANCED MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:BALANCED MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC. TREASURY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-846-6328
Mailing Address - Street 1:130 E CEDAR ST STE 2
Mailing Address - Street 2:P.O. BOX 827
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-2502
Mailing Address - Country:US
Mailing Address - Phone:989-846-6328
Mailing Address - Fax:
Practice Address - Street 1:130 E CEDAR ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-2502
Practice Address - Country:US
Practice Address - Phone:989-846-6328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5889910001Medicare NSC
MI5189711Medicare PIN