=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083937122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADB MEDICAL SUPPLIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2010
-----------------------------------------------------
Last Update Date | 03/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 HARRISON AVE SUITE 3
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45030-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-347-2752
-----------------------------------------------------
Fax | 513-202-1370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 HARRISON AVE SUITE 3
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45030-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-347-2752
-----------------------------------------------------
Fax | 513-202-1370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. ANTHONY DAVID BAMONTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-347-2752
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BN1400X
-----------------------------------------------------
Taxonomy Name | Nursing Facility Supplies (DME)
-----------------------------------------------------
License Number | 2882411
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------