Provider Demographics
NPI:1710919725
Name:DIVERSIFIED MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-253-0611
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-0286
Mailing Address - Country:US
Mailing Address - Phone:419-253-0611
Mailing Address - Fax:419-253-0711
Practice Address - Street 1:2260 COUNTY ROAD 26
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-9776
Practice Address - Country:US
Practice Address - Phone:419-253-0611
Practice Address - Fax:419-253-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD22OtherMEDIGOLD
OH0678735Medicaid
OH5756570001Medicare NSC