MEDICARE: BOARDMAN MEDICAL SUPPLY CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1407100621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARDMAN MEDICAL SUPPLY CO

Provider Business Mailing Address
First Line	:	300 N STATE ST
Second Line	:
City	:	GIRARD
State	:	OH
Zip	:	44420-2538
Country	:	US
Telephone Number	:	330-545-6700
Fax Number	:	330-545-5555

Provider Business Practice Location Address
First Line	:	2320 LAKE AVE
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3440
Country	:	US
Telephone Number	:	440-536-5593
Fax Number	:	440-536-5597

Authorized Official
Title or Position	:	VICE PRESIDENT/GM
Name	:	MS. ROBIN S. IVANY
Credential	:
Telephone Number	:	330-545-6700

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	03/08/2018

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