Healthcare Provider Details

I. General information

NPI: 1295148195
Provider Name (Legal Business Name): ADAPTIVE MEDICAL MARKETING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 BELLEFONTAINE AVE
LIMA OH
45804
US

IV. Provider business mailing address

1378 BELLEFONTAINE AVE
LIMA OH
45804
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-5410
  • Fax: 419-222-6566
Mailing address:
  • Phone: 419-224-5410
  • Fax: 419-222-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHANTELL T SHREVES
Title or Position: PRESIDENT
Credential: RRT
Phone: 419-224-5410