Healthcare Provider Details

I. General information

NPI: 1609831395
Provider Name (Legal Business Name): BOARDMAN MEDICAL SUPPLY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/21/2022
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N STATE ST
GIRARD OH
44420-2538
US

IV. Provider business mailing address

300 N STATE ST
GIRARD OH
44420-2538
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-6700
  • Fax: 330-545-5555
Mailing address:
  • Phone: 330-545-6700
  • Fax: 330-545-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. ROBIN S. IVANY
Title or Position: VICE PRESIDENT
Credential:
Phone: 330-545-6700