Provider Demographics
NPI:1861786337
Name:MCPARK, INC.
Entity type:Organization
Organization Name:MCPARK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-866-7033
Mailing Address - Street 1:55 E LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4738
Mailing Address - Country:US
Mailing Address - Phone:248-866-7033
Mailing Address - Fax:248-584-5648
Practice Address - Street 1:55 E LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4738
Practice Address - Country:US
Practice Address - Phone:248-866-7033
Practice Address - Fax:248-584-5648
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCPARK , INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies