Provider Demographics
NPI:1477895662
Name:MED-SYSTEMS OF FRANKLIN FURNACE, LLC
Entity type:Organization
Organization Name:MED-SYSTEMS OF FRANKLIN FURNACE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-526-0124
Mailing Address - Street 1:4734 GALLIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-8600
Mailing Address - Country:US
Mailing Address - Phone:419-526-0124
Mailing Address - Fax:419-522-4391
Practice Address - Street 1:4734 GALLIA PIKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-8600
Practice Address - Country:US
Practice Address - Phone:419-512-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1179314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081291Medicaid
OH366003Medicare Oscar/Certification