Provider Demographics
NPI:1447319553
Name:PROFESSIONAL MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:C
Authorized Official - Last Name:DETWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-492-7377
Mailing Address - Street 1:4397 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2643
Mailing Address - Country:US
Mailing Address - Phone:330-492-7377
Mailing Address - Fax:330-491-2138
Practice Address - Street 1:4397 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2643
Practice Address - Country:US
Practice Address - Phone:330-492-7377
Practice Address - Fax:330-491-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH142332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2135620Medicaid
OH1269080002Medicare NSC