Provider Demographics
NPI:1699740530
Name:COUSINS MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:COUSINS MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESSEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-478-0099
Mailing Address - Street 1:5517 TELEGRAPH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-3630
Mailing Address - Country:US
Mailing Address - Phone:419-478-0099
Mailing Address - Fax:419-478-0097
Practice Address - Street 1:5517 TELEGRAPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-3630
Practice Address - Country:US
Practice Address - Phone:419-478-0099
Practice Address - Fax:419-478-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1457240332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546614Medicaid
MI4726282Medicaid
OH2546614Medicaid