Provider Demographics
NPI:1760497366
Name:MEDI-WISE HEALTH MART INC
Entity Type:Organization
Organization Name:MEDI-WISE HEALTH MART INC
Other - Org Name:DONALDSON MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-364-2273
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663
Mailing Address - Country:US
Mailing Address - Phone:330-364-2273
Mailing Address - Fax:330-364-4182
Practice Address - Street 1:821 ANOLA AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2075
Practice Address - Country:US
Practice Address - Phone:330-364-2273
Practice Address - Fax:330-364-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155532OtherANTHEM
OH0496468Medicaid
OH0291630001Medicare NSC