Provider Demographics
NPI:1699754366
Name:M E D SUPPLIES INC
Entity type:Organization
Organization Name:M E D SUPPLIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-976-0999
Mailing Address - Street 1:4005 BACH BUXTON RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1047
Mailing Address - Country:US
Mailing Address - Phone:513-965-0999
Mailing Address - Fax:513-965-9777
Practice Address - Street 1:4005 BACH BUXTON RD
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1047
Practice Address - Country:US
Practice Address - Phone:513-965-0999
Practice Address - Fax:513-965-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1201482332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200338670AMedicaid
OH31175086003OtherMEDICAL MUTUAL OF OHIO
OH000000204799OtherANTHEM
OH2228262Medicaid
KY90002437Medicaid
OH2228262Medicaid