Provider Demographics
NPI:1164830667
Name:HOMETOWN MEDICAL SUPPLY
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL SUPPLY
Other - Org Name:HOMETOWN MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-203-5883
Mailing Address - Street 1:488 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2633
Mailing Address - Country:US
Mailing Address - Phone:636-203-5883
Mailing Address - Fax:800-522-3601
Practice Address - Street 1:488 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2633
Practice Address - Country:US
Practice Address - Phone:636-203-5883
Practice Address - Fax:800-522-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies