Provider Demographics
NPI:1043202328
Name:MAHONING MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:MAHONING MEDICAL EQUIPMENT INC.
Other - Org Name:MAHONING MEDICAL SUPPLY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-259-0054
Mailing Address - Street 1:60 N CANFIELD NILES RD
Mailing Address - Street 2:STE 100
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2340
Mailing Address - Country:US
Mailing Address - Phone:330-259-0054
Mailing Address - Fax:330-797-8840
Practice Address - Street 1:60 N CANFIELD NILES RD
Practice Address - Street 2:STE 100
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2340
Practice Address - Country:US
Practice Address - Phone:330-259-0054
Practice Address - Fax:330-797-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH90010286332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2407167Medicaid
OH2407167Medicaid