MEDICARE: ULTIMATE MEDICAL SUPPLIES, INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200904203068	OTHER	OH	STATE LICENSE

General Provider Information

NPI Number	:	1760622427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE MEDICAL SUPPLIES, INC

Provider Business Mailing Address
First Line	:	2242 S HAMILTON RD
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4300
Country	:	US
Telephone Number	:	614-868-6970
Fax Number	:	614-868-6980

Provider Business Practice Location Address
First Line	:	2242 S HAMILTON RD
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4300
Country	:	US
Telephone Number	:	614-868-6970
Fax Number	:	614-868-6980

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. TAMBA TANDANPOLIE
Credential	:
Telephone Number	:	614-218-7002

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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