=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346643640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDADAPT LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2014
-----------------------------------------------------
Last Update Date | 06/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 HANLEY RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45247-5049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-923-1181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4150 HANLEY RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45247-5049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-923-1181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL MANAGER
-----------------------------------------------------
Name | MR. RAY NERSWICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-923-1181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WH0202X
-----------------------------------------------------
Taxonomy Name | Home Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------