Provider Demographics
NPI:1902948805
Name:MODERN MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:MODERN MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-627-9949
Mailing Address - Street 1:P.O. BOX 345
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721
Mailing Address - Country:US
Mailing Address - Phone:231-627-9949
Mailing Address - Fax:231-627-8294
Practice Address - Street 1:127 N. MAIN STREET
Practice Address - Street 2:RETAIL PHARMACY
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721
Practice Address - Country:US
Practice Address - Phone:231-627-9949
Practice Address - Fax:231-627-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2700732Medicaid
MI540A602530OtherBLUE CROSS
MI872700732Medicaid
MI2700732Medicaid