Provider Demographics
NPI:1043411705
Name:ON THE GO HME, INC.
Entity Type:Organization
Organization Name:ON THE GO HME, INC.
Other - Org Name:ON THE GO HOME MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:ALLMON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:712-256-9595
Mailing Address - Street 1:2201 W BROADWAY
Mailing Address - Street 2:BAY #4
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3605
Mailing Address - Country:US
Mailing Address - Phone:712-256-9595
Mailing Address - Fax:712-256-9596
Practice Address - Street 1:2201 W BROADWAY
Practice Address - Street 2:BAY #4
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3605
Practice Address - Country:US
Practice Address - Phone:712-256-9595
Practice Address - Fax:712-256-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0400114Medicaid
NE10025582200Medicaid
IA70111OtherBCBS
IA0400114Medicaid