=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710919725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVERSIFIED MEDICAL PRODUCTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 03/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2260 COUNTY ROAD 26
-----------------------------------------------------
City | MARENGO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43334-9776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-253-0611
-----------------------------------------------------
Fax | 419-253-0711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 286
-----------------------------------------------------
City | MARENGO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43334-0286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-253-0611
-----------------------------------------------------
Fax | 419-253-0711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. RHONDA MAPLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-253-0611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------