Provider Demographics
NPI:1184602518
Name:PRENTKE ROMICH COMPANY
Entity type:Organization
Organization Name:PRENTKE ROMICH COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:800-262-1984
Mailing Address - Street 1:1022 HEYL RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9786
Mailing Address - Country:US
Mailing Address - Phone:330-262-1984
Mailing Address - Fax:330-263-4829
Practice Address - Street 1:1022 HEYL RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9786
Practice Address - Country:US
Practice Address - Phone:330-262-1984
Practice Address - Fax:330-263-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85-025064332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0286195Medicaid
IN100013680AMedicaid
AZ302703001Medicaid
CAXDME01192Medicaid