Provider Demographics
NPI:1356367783
Name:OCEANA HOME MEDICAL EQUIPMENT PLUS
Entity type:Organization
Organization Name:OCEANA HOME MEDICAL EQUIPMENT PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-861-0276
Mailing Address - Street 1:303 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-9692
Mailing Address - Country:US
Mailing Address - Phone:231-861-0276
Mailing Address - Fax:231-861-0276
Practice Address - Street 1:169 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-1024
Practice Address - Country:US
Practice Address - Phone:231-861-8240
Practice Address - Fax:231-861-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40500OtherHEALTH PLAN OF MICHIGAN
MI40500OtherHEALTH PLAN OF MICHIGAN