Provider Demographics
NPI:1245215797
Name:PHILLIPS MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:PHILLIPS MEDICAL EQUIPMENT LLC
Other - Org Name:PEOPLES HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-733-7000
Mailing Address - Street 1:1174 MONTICELLO ST SW
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2329
Mailing Address - Country:US
Mailing Address - Phone:678-658-4663
Mailing Address - Fax:678-658-4664
Practice Address - Street 1:1174 MONTICELLO ST SW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2329
Practice Address - Country:US
Practice Address - Phone:678-658-4663
Practice Address - Fax:678-658-4664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED RESOURCES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-07
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 332BX2000X
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101103AMedicaid
GA003101103AMedicaid