Organization
AIRWAY OXYGEN INC
Active
Parent organization
GRANITE HOLDINGS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANITE HOLDINGS INC
Authorized official
STEPHEN W NYHUIS (PRESIDENT)
(616) 247-3900
Entity
Organization
Contact information
Practice address
2540 28TH ST SW, WYOMING, MI 49519-2106
(616) 328-8780
(616) 328-8782
Mailing address
PO BOX 9950, WYOMING, MI 49509-9918
(616) 247-3900
(616) 247-0776
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5019426
—
MI
01
—
540D10642
BLUE CROSS/BLUE SHIELD OF MICHIGAN
MI
Enumeration date
08/05/2009
Last updated
08/11/2016
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