Provider Demographics
NPI:1518394311
Name:NORTH CENTRAL MEDICAL RESOURCES, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL MEDICAL RESOURCES, INC.
Other - Org Name:AULTMAN HOME MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-452-9911
Mailing Address - Street 1:5220 TUSCARAWAS ST W
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-5055
Mailing Address - Country:US
Mailing Address - Phone:330-478-9623
Mailing Address - Fax:330-478-6026
Practice Address - Street 1:6046 WHIPPLE AVE NW
Practice Address - Street 2:SUITE #210
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7616
Practice Address - Country:US
Practice Address - Phone:330-433-1236
Practice Address - Fax:330-433-1571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CENTRAL MEDICAL RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-11
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255373858Medicare PIN