Provider Demographics
NPI:1801836309
Name:CANFIELD MEDICAL SUPPLY AND SERVICES, LLC
Entity Type:Organization
Organization Name:CANFIELD MEDICAL SUPPLY AND SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-533-1914
Mailing Address - Street 1:4120 BOARDMAN-CANFIELD RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9003
Mailing Address - Country:US
Mailing Address - Phone:330-533-1914
Mailing Address - Fax:330-533-6635
Practice Address - Street 1:4120 BOARDMAN-CANFIELD RD.
Practice Address - Street 2:SUITE A
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9003
Practice Address - Country:US
Practice Address - Phone:330-533-1914
Practice Address - Fax:330-533-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-088516332BC3200X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149339Medicaid
OH0969582Medicaid
OH000000155785OtherANTHEM BC BS
OH0969582Medicaid