1295894632 NPI number — HOME MED PLUS, INC.

Table of content: (NPI 1295894632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295894632 NPI number — HOME MED PLUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME MED PLUS, 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:
1295894632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-667-1269
Provider Business Mailing Address Fax Number:
800-859-8835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5113 PACIFIC HWY E
Provider Second Line Business Practice Location Address:
STE. 8
Provider Business Practice Location Address City Name:
FIFE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98424-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-926-0198
Provider Business Practice Location Address Fax Number:
800-859-8835
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUMEAU
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-307-0050

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  00069542-S , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9050857 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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