Provider Demographics
NPI:1295717783
Name:TRADE MASTERS INC
Entity type:Organization
Organization Name:TRADE MASTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-545-2800
Mailing Address - Street 1:555 CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1411
Mailing Address - Country:US
Mailing Address - Phone:330-746-2537
Mailing Address - Fax:330-744-5127
Practice Address - Street 1:555 CATALINA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1411
Practice Address - Country:US
Practice Address - Phone:330-746-2537
Practice Address - Fax:330-744-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0682499Medicaid
OH000000155766OtherANTHEM INSURANCE
PA007111781Medicaid
OH0682499Medicaid
PA0315960001Medicare NSC