Provider Demographics
NPI:1336316967
Name:MODERN MEDICAL INC
Entity Type:Organization
Organization Name:MODERN MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-657-3330
Mailing Address - Street 1:7840 GRAPHICS WAY
Mailing Address - Street 2:POST OFFICE BOX 549
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8002
Mailing Address - Country:US
Mailing Address - Phone:740-657-3330
Mailing Address - Fax:740-657-3337
Practice Address - Street 1:7840 GRAPHICS WAY
Practice Address - Street 2:POST OFFICE BOX 549
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8002
Practice Address - Country:US
Practice Address - Phone:740-657-3330
Practice Address - Fax:740-657-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 251J00000X, 332S00000X, 333600000X, 335E00000X, 3416A0800X, 3416L0300X, 3416S0300X, 343800000X, 343900000X, 344600000X, 347C00000X, 347E00000X
OHHMEP 33010332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker