Provider Demographics
NPI:1003929936
Name:AFFINITY HOME MEDICAL INC.
Entity Type:Organization
Organization Name:AFFINITY HOME MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:O'GWYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-666-2002
Mailing Address - Street 1:724 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-5112
Mailing Address - Country:US
Mailing Address - Phone:251-666-2002
Mailing Address - Fax:251-666-2202
Practice Address - Street 1:724 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-5112
Practice Address - Country:US
Practice Address - Phone:251-666-2002
Practice Address - Fax:251-666-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL436332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911385Medicaid
AL009911385Medicaid