Healthcare Provider Details

I. General information

NPI: 1396746525
Provider Name (Legal Business Name): CKC MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25671 FORT MEIGS RD SUITE A
PERRYSBURG OH
43551-1191
US

IV. Provider business mailing address

25671 FORT MEIGS RD SUITE A
PERRYSBURG OH
43551-1191
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-4775
  • Fax: 419-872-4776
Mailing address:
  • Phone: 419-872-4775
  • Fax: 419-872-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHMER 22028
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHMER 22028
License Number StateOH

VIII. Authorized Official

Name: MR. IBE U NNAJI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 419-872-4775