Provider Demographics
NPI:1841306727
Name:C & M MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:C & M MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRESTON
Authorized Official - Middle Name:LENELL
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-872-0033
Mailing Address - Street 1:8600 S WILKINSON WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2598
Mailing Address - Country:US
Mailing Address - Phone:419-872-0033
Mailing Address - Fax:
Practice Address - Street 1:8600 S WILKINSON WAY
Practice Address - Street 2:SUITE C
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2598
Practice Address - Country:US
Practice Address - Phone:419-872-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2680960Medicaid
OH2680960Medicaid