Provider Demographics
NPI:1770881237
Name:INDEPENDENT SENIOR SUPPLIES, INC
Entity type:Organization
Organization Name:INDEPENDENT SENIOR SUPPLIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-290-8935
Mailing Address - Street 1:6826 CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8429
Mailing Address - Country:US
Mailing Address - Phone:440-290-8935
Mailing Address - Fax:440-290-8967
Practice Address - Street 1:6826 CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8429
Practice Address - Country:US
Practice Address - Phone:440-290-8935
Practice Address - Fax:440-290-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3133862Medicaid