MEDICARE: M & R OF FREDERICKTOWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	NONE REQUIRED	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720081581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & R OF FREDERICKTOWN

Provider Business Mailing Address
First Line	:	895 HOME AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-4115
Country	:	US
Telephone Number	:	800-998-4199
Fax Number	:

Provider Business Practice Location Address
First Line	:	895 HOME AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-4115
Country	:	US
Telephone Number	:	800-998-4199
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL J HOUSKA
Credential	:
Telephone Number	:	800-998-4199

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/02/2009

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Directions to “M & R OF FREDERICKTOWN ” Practice Location

Language	Start Address	Practice Location

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