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General NPI Number Information
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NPI Number | 1174524797
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Entity Type | Organization
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Legal Business Name | MODERN MEDICAL, INC.
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 250 PROGRESSIVE WAY SUITE 100
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City | WESTERVILLE
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State | OH
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Zip | 43082-9615
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Country | US
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Telephone | 800-547-3330
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Fax | 614-212-8008
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Provider Business Mailing Address
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Address Line | 250 PROGRESSIVE WAY SUITE 100
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City | WESTERVILLE
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State | OH
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Zip | 43082-9615
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Country | US
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Telephone | 800-547-3330
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Fax | 614-212-8008
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | JOHN WILLIAM BENCIVENGA
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Credential |
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Telephone | 813-318-6831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | HMER 23503
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License Number State | OH
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