Provider Demographics
NPI:1275767584
Name:HOMEWELL MEDICAL INC
Entity Type:Organization
Organization Name:HOMEWELL MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TYSON
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-605-9327
Mailing Address - Street 1:360 N MOUNT ZION RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-8330
Mailing Address - Country:US
Mailing Address - Phone:317-605-9327
Mailing Address - Fax:866-906-1187
Practice Address - Street 1:360 N MOUNT ZION RD
Practice Address - Street 2:SUITE D
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-8330
Practice Address - Country:US
Practice Address - Phone:317-605-9327
Practice Address - Fax:866-906-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000592A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6401420001Medicare NSC