1114079407 NPI number — HOME MEDICAL SUPPLIES, INC.

Table of content: (NPI 1114079407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114079407 NPI number — HOME MEDICAL SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME MEDICAL SUPPLIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114079407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4209 LAKELAND DR
Provider Second Line Business Mailing Address:
SUITE 294
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-9212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-425-8900
Provider Business Mailing Address Fax Number:
866-428-8900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2260 S XANADU WAY
Provider Second Line Business Practice Location Address:
SUITE 335
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014-1373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-705-1990
Provider Business Practice Location Address Fax Number:
866-428-8900
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
303-705-1990

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00183014 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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