Provider Demographics
NPI:1396746525
Name:CKC MEDICAL INC
Entity type:Organization
Organization Name:CKC MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IBE
Authorized Official - Middle Name:U
Authorized Official - Last Name:NNAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-872-4775
Mailing Address - Street 1:25671 FORT MEIGS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1191
Mailing Address - Country:US
Mailing Address - Phone:419-872-4775
Mailing Address - Fax:419-872-4776
Practice Address - Street 1:25671 FORT MEIGS RD
Practice Address - Street 2:SUITE A
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1191
Practice Address - Country:US
Practice Address - Phone:419-872-4775
Practice Address - Fax:419-872-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER 22028332BP3500X, 332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015018Medicaid
OH0000002498007OtherANTHEM BCBS MANSFIELD
OH000000249807OtherANTHEM BCBS PERRYSBURG
OH8700304OtherINDIVIDUAL OPTIONS
OH2015018Medicaid
OH=========002OtherMEDICAL MUTUAL P'BURG
OH=========-00OtherBWC
OH=========002OtherMEDICAL MUTUAL P'BURG