Provider Demographics
NPI:1275571838
Name:HOSPICE MEDICAL EQUIPMENT CENTER, INC.
Entity Type:Organization
Organization Name:HOSPICE MEDICAL EQUIPMENT CENTER, INC.
Other - Org Name:FAMILY MEDICAL EQUIPMENT AND SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:940-839-6425
Mailing Address - Street 1:100 S PARK LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5750
Mailing Address - Country:US
Mailing Address - Phone:580-482-9410
Mailing Address - Fax:580-482-4648
Practice Address - Street 1:100 S PARK LN
Practice Address - Street 2:SUITE 1
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5750
Practice Address - Country:US
Practice Address - Phone:580-482-9410
Practice Address - Fax:580-482-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK176637332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100808130-AMedicaid
OK0154100001Medicare NSC