Provider Demographics
NPI:1154313914
Name:FIELDS MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:FIELDS MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-298-3674
Mailing Address - Street 1:2138 BLACKLOG ROAD
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-0000
Mailing Address - Country:US
Mailing Address - Phone:606-298-3674
Mailing Address - Fax:606-298-0724
Practice Address - Street 1:2138 BLACKLOG ROAD
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-0000
Practice Address - Country:US
Practice Address - Phone:606-298-3674
Practice Address - Fax:606-298-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY083898251S00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8855106000Medicaid
KY45907813OtherEPSDT
KY90100801Medicaid
KY1080850001Medicare NSC
WV8855106000Medicaid