Organization
LTC SUPPLY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICK L RAYNARD (BILLING MANAGER)
(614) 297-6967
Entity
Organization
Contact information
Practice address
150 SMOKERISE DR, WADSWORTH, OH 44281-8701
(614) 297-6967
(614) 297-7380
Mailing address
150 SMOKERISE DR, WADSWORTH, OH 44281-8701
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0218857
—
OH
Enumeration date
11/15/2006
Last updated
06/10/2008
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