MEDICARE: CKC DURABLE MEDICAL SUPPLIES, LLC

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	:	1568646651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CKC DURABLE MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	4104 AIRPORT HWY
Second Line	:	4040 PLAZA
City	:	TOLEDO
State	:	OH
Zip	:	43615-7100
Country	:	US
Telephone Number	:	419-382-7050
Fax Number	:	419-382-7051

Provider Business Practice Location Address
First Line	:	4104 AIRPORT HWY
Second Line	:	4040 PLAZA
City	:	TOLEDO
State	:	OH
Zip	:	43615-7100
Country	:	US
Telephone Number	:	419-382-7050
Fax Number	:	419-382-7051

Authorized Official
Title or Position	:	MANAGER / MEMBER
Name	:	MR. IBE UGONNA NNAJI
Credential	:
Telephone Number	:	419-867-1717

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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