Provider Demographics
NPI:1710089982
Name:MARK II ENT., LTD
Entity Type:Organization
Organization Name:MARK II ENT., LTD
Other - Org Name:MED-OX HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-323-5764
Mailing Address - Street 1:4867 URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9503
Mailing Address - Country:US
Mailing Address - Phone:937-323-5764
Mailing Address - Fax:937-323-2699
Practice Address - Street 1:4867 URBANA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9503
Practice Address - Country:US
Practice Address - Phone:937-323-5764
Practice Address - Fax:937-323-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11067332B00000X
OH3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2070360Medicaid
OH2070360Medicaid