Michigan Diabetes Supplies LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MICHIGAN DIABETES SUPPLIES LLC

Doing business as

MICHIGAN DIABETES SUPPLIES LCC

Practice address

4038 Grange Hall Rd
Holly, MI 48442-1160

Phone

(800) 321-5290

Fax

(248) 634-2040

NPI assigned

Sep 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Everard Lester Dominy

Title

Owner

Phone

(800) 321-5290

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MICHIGAN DIABETES SUPPLIES LCC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356441687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4038 GRANGE HALL RD",
            "city": "HOLLY",
            "state": "MI",
            "postal_code": "484421160",
            "telephone_number": "800-321-5290",
            "fax_number": "248-634-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4038 GRANGE HALL RD",
            "city": "HOLLY",
            "state": "MI",
            "postal_code": "484421160",
            "telephone_number": "800-321-5290",
            "fax_number": "248-634-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN DIABETES SUPPLIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOMINY",
        "authorized_official_first_name": "EVERARD",
        "authorized_official_middle_name": "LESTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-321-5290",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2893512",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MICHIGAN DIABETES SUPPLIES LCC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Bernice McDonald, PT
• Douglas McDonald
• Gina Marie McEachern, OTR
• Andrea Meador
• Flor Canela Medina
• Jessica Marie Miller, LLBSW, RAC
• Chris Richard Milowe Sr., R.N.
• Mission Point Healthcare Holdings, LLC
• Mission Point Healthcare Holdings, LLC
• Carole Mohsen, RPH

• Durable Medical Equipment & Medical Supplies in Holly, MI
• Providers in Holly, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.