Provider Demographics
NPI:1528144060
Name:IDEAL MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:IDEAL MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUPOVLYANSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-238-0878
Mailing Address - Street 1:2658 W BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3329
Mailing Address - Country:US
Mailing Address - Phone:614-238-0878
Mailing Address - Fax:614-343-7110
Practice Address - Street 1:2872 WEST BROAD STREET STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2645
Practice Address - Country:US
Practice Address - Phone:614-238-0878
Practice Address - Fax:614-343-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2562105Medicaid
OH2890108Medicaid
OH5408580001Medicare NSC