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General NPI Number Information
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NPI Number | 1194722215
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Entity Type | Organization
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Legal Business Name | MIDWEST MEDICAL SUPPLY CORP.
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 24340 SPERRY DR 1ST FLOOR
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City | WESTLAKE
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State | OH
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Zip | 44145-1565
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Country | US
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Telephone | 440-835-0660
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Fax | 440-835-2029
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Provider Business Mailing Address
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Address Line | 24340 SPERRY DR 1ST FLOOR
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City | WESTLAKE
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State | OH
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Zip | 44145-1565
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Country | US
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Telephone | 440-835-0660
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Fax | 440-835-2029
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. NORMAN A. FOX JR.
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Credential |
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Telephone | 440-617-2113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 18481231
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License Number State | OH
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