Provider Demographics
NPI:1083798367
Name:HOME EMERGENCY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:HOME EMERGENCY MEDICAL SUPPLY INC
Other - Org Name:PACIFIC MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:RUDDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:503-585-2027
Mailing Address - Street 1:1090 COMMERCIAL ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1057
Mailing Address - Country:US
Mailing Address - Phone:503-585-2027
Mailing Address - Fax:503-585-0789
Practice Address - Street 1:1090 COMMERCIAL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1057
Practice Address - Country:US
Practice Address - Phone:503-585-2027
Practice Address - Fax:503-585-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1293539-0332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240589Medicaid
OR240589Medicaid