Provider Demographics
NPI:1750188728
Name:DIVERSA MEDICAL SUPPLY LTD
Entity type:Organization
Organization Name:DIVERSA MEDICAL SUPPLY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN MGR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:330-239-0969
Mailing Address - Street 1:4695 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9758
Mailing Address - Country:US
Mailing Address - Phone:330-239-0969
Mailing Address - Fax:
Practice Address - Street 1:4695 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9758
Practice Address - Country:US
Practice Address - Phone:330-239-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies