Basic Information
| Provider Information | |||||||||
| NPI: | 1871699397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | O E MEYER CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 479 | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448710479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196251256 | ||||||||
| FaxNumber: | 4196253999 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 E 28TH ST | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440551908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402778922 | ||||||||
| FaxNumber: | 4402770641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | BELDEN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4196251256 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | O E MEYER CO | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 22031 | OH | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 2309755 | 05 | OH | MEDICAID | 000000155699 | 01 | OH | ANTHEM | OTHER |