Provider Demographics
NPI:1225007685
Name:HOMETOWN MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-369-1425
Mailing Address - Street 1:516 JOEL BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4305
Mailing Address - Country:US
Mailing Address - Phone:239-369-1425
Mailing Address - Fax:239-369-5927
Practice Address - Street 1:516 JOEL BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4305
Practice Address - Country:US
Practice Address - Phone:239-369-1425
Practice Address - Fax:239-369-5927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026226900Medicaid
FL026226900Medicaid