Provider Demographics
NPI:1558433482
Name:LTC SUPPLY CORPORATION
Entity Type:Organization
Organization Name:LTC SUPPLY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-297-6967
Mailing Address - Street 1:150 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 SMOKERISE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8701
Practice Address - Country:US
Practice Address - Phone:614-297-6967
Practice Address - Fax:614-297-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0218857Medicaid
OH0218857Medicaid