Provider Demographics
NPI:1386685097
Name:PRO-MED HOME MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:PRO-MED HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-523-5500
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0811
Mailing Address - Country:US
Mailing Address - Phone:276-523-5500
Mailing Address - Fax:276-523-5560
Practice Address - Street 1:514 WOOD AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3018
Practice Address - Country:US
Practice Address - Phone:276-523-5500
Practice Address - Fax:276-523-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA229456OtherBLUE CROSS & BLUE SHIELD
400481OtherBLACK LUNG
VA0100OtherJOHN DEERE HEALTH CARE
KY90002221Medicaid
1314990001Medicare ID - Type Unspecified