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General NPI Number Information
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NPI Number | 1356559959
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Entity Type | Organization
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Legal Business Name | MED-CARE CONVALESCENT SUPPLY CO. INC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 AVONDALE DR
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City | DAYTON
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State | OH
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Zip | 45404-2123
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Country | US
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Telephone | 937-236-0527
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Fax | 937-237-9192
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Provider Business Mailing Address
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Address Line | 109 AVONDALE DR
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City | DAYTON
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State | OH
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Zip | 45404-2123
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Country | US
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Telephone | 937-236-0527
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Fax | 937-237-9192
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLLIAM T HOPWOOD
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Credential | OWNER
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Telephone | 937-236-0527
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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 | 57-154864
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License Number State | OH
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