Provider Demographics
NPI:1871542860
Name:DAVISMADE, INC.
Entity type:Organization
Organization Name:DAVISMADE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-742-0581
Mailing Address - Street 1:2511 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-3649
Mailing Address - Country:US
Mailing Address - Phone:810-233-9706
Mailing Address - Fax:810-233-9716
Practice Address - Street 1:2511 DAVISON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3649
Practice Address - Country:US
Practice Address - Phone:810-233-9706
Practice Address - Fax:810-233-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME-0159374332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30010915Medicaid
MI2771752Medicaid
VA9113941Medicaid
SD9162430Medicaid
NY01652524Medicaid
MI663880OtherHAP
OH0956541Medicaid
INDA J54840Medicaid
INDA J54840Medicaid
MI2771752Medicaid