Provider Demographics
NPI:1043729452
Name:YAMACO HOME HEALTH MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:YAMACO HOME HEALTH MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:ZACCHEUS
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:763-234-6433
Mailing Address - Street 1:6040 EARLE BROWN DR STE 270
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4527
Mailing Address - Country:US
Mailing Address - Phone:763-703-5986
Mailing Address - Fax:763-600-6102
Practice Address - Street 1:8903 PINEVIEW LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6557
Practice Address - Country:US
Practice Address - Phone:763-843-5987
Practice Address - Fax:763-600-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies