Provider Demographics
NPI:1215215116
Name:HOMETOWN OXYGEN PITTSBURGH LLC
Entity Type:Organization
Organization Name:HOMETOWN OXYGEN PITTSBURGH LLC
Other - Org Name:ESMS HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-373-1472
Mailing Address - Street 1:35 SARHELM RD
Mailing Address - Street 2:HOMETOWN OXYGEN PITTSBURGH LLC C/O DYNAMIC HEALTHCARE S
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-3339
Mailing Address - Country:US
Mailing Address - Phone:717-657-2100
Mailing Address - Fax:717-920-0630
Practice Address - Street 1:1138 N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1938
Practice Address - Country:US
Practice Address - Phone:724-287-6115
Practice Address - Fax:724-256-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005681200001Medicaid
PA0005681200001Medicaid