Provider Demographics
NPI:1598850059
Name:LTC SUPPLY
Entity Type:Organization
Organization Name:LTC SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-637-2330
Mailing Address - Street 1:2332 CADWALLADER SONK
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410
Mailing Address - Country:US
Mailing Address - Phone:330-637-2330
Mailing Address - Fax:330-637-2372
Practice Address - Street 1:781 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212
Practice Address - Country:US
Practice Address - Phone:614-297-6967
Practice Address - Fax:877-297-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0218857Medicaid
OH1055040001Medicare ID - Type Unspecified