Provider Demographics
NPI:1174524797
Name:MODERN MEDICAL, INC.
Entity type:Organization
Organization Name:MODERN MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BENCIVENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-318-6831
Mailing Address - Street 1:250 PROGRESSIVE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9615
Mailing Address - Country:US
Mailing Address - Phone:800-547-3330
Mailing Address - Fax:614-212-8008
Practice Address - Street 1:250 PROGRESSIVE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9615
Practice Address - Country:US
Practice Address - Phone:800-547-3330
Practice Address - Fax:614-212-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332S00000X, 347E00000X, 335E00000X, 251E00000X, 333600000X, 332B00000X
OHHMER 23503332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
No347E00000XTransportation ServicesTransportation Broker
No335E00000XSuppliersProsthetic/Orthotic Supplier
No251E00000XAgenciesHome Health
No333600000XSuppliersPharmacy