Provider Demographics
NPI:1811934185
Name:PAX MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:PAX MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOKENGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-791-6671
Mailing Address - Street 1:6910 SILVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3702
Mailing Address - Country:US
Mailing Address - Phone:513-791-6671
Mailing Address - Fax:513-791-0643
Practice Address - Street 1:6910 SILVERTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3702
Practice Address - Country:US
Practice Address - Phone:513-791-6671
Practice Address - Fax:513-791-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OH31900221332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2658637Medicaid
5733280001Medicare NSC
578328001Medicare UPIN