Provider Demographics
NPI:1154452555
Name:ELLIS HOME OXYGEN AND MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:ELLIS HOME OXYGEN AND MEDICAL EQUIPMENT
Other - Org Name:CAREPLUS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:276-783-6868
Mailing Address - Street 1:925 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4117
Mailing Address - Country:US
Mailing Address - Phone:276-783-6868
Mailing Address - Fax:276-783-3357
Practice Address - Street 1:2460 LEE HWY
Practice Address - Street 2:SUITE 7
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301
Practice Address - Country:US
Practice Address - Phone:540-980-9551
Practice Address - Fax:540-980-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009243332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0216560002Medicare ID - Type UnspecifiedPROVIDER NUMBER