Provider Demographics
NPI:1356398796
Name:PARADYME MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:PARADYME MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KNISELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-689-0080
Mailing Address - Street 1:3996 KENT RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4227
Mailing Address - Country:US
Mailing Address - Phone:330-689-0080
Mailing Address - Fax:330-689-0068
Practice Address - Street 1:3996 KENT RD
Practice Address - Street 2:BLDG A
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4227
Practice Address - Country:US
Practice Address - Phone:330-689-0080
Practice Address - Fax:330-689-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER-22452332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90006875Medicaid
OH000000241580OtherBLUE CROSS / BLUE SHIELD
OH2285638Medicaid
OH4239340001Medicare NSC