Organization
BOARDMAN MEDICAL SUPPLY CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN S IVANY (VICE PRESIDENT/GM)
(330) 545-6700
Entity
Organization
Contact information
Practice address
1204 30TH ST NW, CANTON, OH 44709-2923
(330) 492-4300
(330) 492-7886
Mailing address
300 N STATE ST, GIRARD, OH 44420-2538
(330) 545-6700
(330) 545-5555
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2627741
—
OH
Enumeration date
12/12/2006
Last updated
12/08/2020
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