Provider Demographics
NPI:1720081581
Name:M & R OF FREDERICKTOWN
Entity Type:Organization
Organization Name:M & R OF FREDERICKTOWN
Other - Org Name:MEDICAL SOLUTIONS & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-998-4199
Mailing Address - Street 1:895 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-4115
Mailing Address - Country:US
Mailing Address - Phone:800-998-4199
Mailing Address - Fax:
Practice Address - Street 1:895 HOME AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-4115
Practice Address - Country:US
Practice Address - Phone:800-998-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNONE REQUIRED332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2263821Medicaid
OH=========027OtherCARESOURCE
OH2263821Medicaid
OH=========005OtherMEDICAL MUTUAL OF OHIO
OH=========027OtherCARESOURCE