Organization
OLD WORLD DME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BILLY LEE COOPER M.B.A. (PRESIDENT)
(248) 669-2416
Entity
Organization
Contact information
Practice address
7475 SHEFFIELD, WEST BLOOMFIELD, MI 48322-2878
(248) 669-2416
(248) 671-0922
Mailing address
7475 SHEFFIELD, WEST BLOOMFIELD, MI 48322-2878
(248) 669-2416
(248) 671-0922
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MI
332BX2000X
Oxygen Equipment & Supplies (DME)
—
MI
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F38288
BCBSM
MI
01
—
0F38288
BCBS
—
Enumeration date
06/22/2009
Last updated
03/01/2019
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