Organization Active NPI

Interdisciplinary Medical MGT

  • Durable Medical Equipment & Medical Supplies
  • Warren, OH
National Provider Identifier
1104904663
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
6881 Issued in OH
Legal business name
INTERDISCIPLINARY MEDICAL MGT
Practice address
2103 Niles Cortland Rd
Warren, OH 44484
Phone
(330) 544-3737
Fax
(330) 544-3904
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Catherine A Stychno, OWNER
Title
President
Phone
(330) 544-3737

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 6881 OH
Durable Medical Equipment & Medical Supplies 332B00000X 6881 OH Primary

Addresses

Primary practice location

2103 Niles Cortland Rd
Warren, OH 44484

Mailing address

2103 Niles Cortland Rd
Warren, OH 44484
Phone (330) 544-3737

Other identifiers 1

IdentifierTypeStateIssuer
2365202MedicaidOH

Other names 1

  • Great East Rehab Inc Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1104904663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 NILES CORTLAND RD",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "44484",
            "telephone_number": "330-544-3737",
            "fax_number": "330-544-3904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 NILES CORTLAND RD",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "44484",
            "telephone_number": "330-544-3737",
            "fax_number": "330-544-3904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERDISCIPLINARY MEDICAL MGT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "STYCHNO",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-544-3737",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "6881",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OH",
            "license": "6881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2365202",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great East Rehab Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.