Provider Demographics
NPI:1033124797
Name:PIONEER HOME MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:PIONEER HOME MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:C
Authorized Official - Last Name:IMPERIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-733-1403
Mailing Address - Street 1:5357 HIGHWAY 86
Mailing Address - Street 2:UNIT 4
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-7448
Mailing Address - Country:US
Mailing Address - Phone:720-733-1403
Mailing Address - Fax:720-733-1404
Practice Address - Street 1:5357 HIGHWAY 86
Practice Address - Street 2:UNIT 4
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7448
Practice Address - Country:US
Practice Address - Phone:720-733-1403
Practice Address - Fax:720-733-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5484070001Medicare ID - Type Unspecified