Healthcare Provider Details

I. General information

NPI: 1174524797
Provider Name (Legal Business Name): MODERN MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PROGRESSIVE WAY SUITE 100
WESTERVILLE OH
43082-9615
US

IV. Provider business mailing address

250 PROGRESSIVE WAY SUITE 100
WESTERVILLE OH
43082-9615
US

V. Phone/Fax

Practice location:
  • Phone: 800-547-3330
  • Fax: 614-212-8008
Mailing address:
  • Phone: 800-547-3330
  • Fax: 614-212-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHMER 23503
License Number StateOH

VIII. Authorized Official

Name: JOHN WILLIAM BENCIVENGA
Title or Position: GENERAL COUNSEL
Credential:
Phone: 813-318-6831