Statewide Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

STATEWIDE MEDICAL SUPPLY LLC

Practice address

28104 Orchard Lake Rd Ste 140
Farmington Hills, MI 48334-3759

Phone

(248) 567-2428

NPI assigned

Mar 19, 2021

Organization subpart

No

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

Authorized official

Name

Bryan Genrich

Title

Director

Phone

(248) 567-2428

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1699351866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28104 ORCHARD LAKE RD STE 140",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343759",
            "telephone_number": "248-567-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28104 ORCHARD LAKE RD STE 140",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343759",
            "telephone_number": "248-567-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEWIDE MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "GENRICH",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "248-567-2428"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.