NPIMap

Organization Active NPI

Mystic Medical Equipment Incorporated

  • Durable Medical Equipment & Medical Supplies
  • Grosse Pointe Woods, MI
National Provider Identifier
1861678831
Registry record updated Aug 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MYSTIC MEDICAL EQUIPMENT INCORPORATED
Practice address
20467 Mack Ave
Grosse Pointe Woods, MI 48236-1654
Phone
(313) 347-8811
NPI assigned
Jan 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2011

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

Authorized official

Name
Dawn Fleeson
Title
Billing Manager
Phone
(248) 476-8811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MI Primary

Addresses

Primary practice location

20467 Mack Ave
Grosse Pointe Woods, MI 48236-1654

Mailing address

PO Box 250843
West Bloomfield, MI 48325-0843

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 16

Organizations listed as members of this organization in the National Provider Directory.

View all 16

Locations

23660 Research Dr
Farmington Hills, MI 48335
Phone (248) 476-8811

20467 Mack Ave
Grosse Pointe Woods, MI 48236
Phone (313) 347-8811

NPI Registry JSON

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

{
    "created_epoch": "1200873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313366400000",
    "number": "1861678831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250843",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483250843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20467 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482361654",
            "telephone_number": "313-347-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MEDICAL EQUIPMENT INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-21",
        "last_updated": "2011-08-15",
        "status": "A",
        "authorized_official_last_name": "FLEESON",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "248-476-8811"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grosse Pointe Woods, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; 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.