Provider Demographics
NPI:1881965713
Name:I C P INC
Entity type:Organization
Organization Name:I C P INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SEIGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-310-2460
Mailing Address - Street 1:1815 W COUNTY ROAD 54
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-7723
Mailing Address - Country:US
Mailing Address - Phone:419-447-6216
Mailing Address - Fax:419-448-7713
Practice Address - Street 1:7537 EASY ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9416
Practice Address - Country:US
Practice Address - Phone:513-573-9625
Practice Address - Fax:513-573-9628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ICP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-24
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065647Medicaid