Healthcare Provider Details

I. General information

NPI: 1659608685
Provider Name (Legal Business Name): JM CLEMENTE CO. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NILES RD SE
WARREN OH
44484-3276
US

IV. Provider business mailing address

3100 NILES RD SE
WARREN OH
44484-3276
US

V. Phone/Fax

Practice location:
  • Phone: 330-392-7069
  • Fax: 330-392-7071
Mailing address:
  • Phone: 330-392-7069
  • Fax: 330-392-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MARK CLEMENTE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 330-392-7069