Provider Demographics
NPI:1215227798
Name:SPEARHEAD HOME MEDICAL LLC
Entity Type:Organization
Organization Name:SPEARHEAD HOME MEDICAL LLC
Other - Org Name:SPEARHEAD HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SPAITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-323-3977
Mailing Address - Street 1:6817 WOLFLIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2176
Mailing Address - Country:US
Mailing Address - Phone:806-418-4706
Mailing Address - Fax:
Practice Address - Street 1:6817 WOLFLIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2176
Practice Address - Country:US
Practice Address - Phone:806-418-4706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2884447-02Medicaid
OK200416730AOtherOKLAHOMA MEDICAID
TX533556OtherBCBS
TX2884447-01Medicaid
NM58475273OtherNEW MEXICO MEDICAID
TX01613306OtherAMERIGROUP
TX288444702OtherSUPERIOR HEALTH PLAN
NM58475273OtherNEW MEXICO MEDICAID