Provider Demographics
NPI:1407856768
Name:COMMUNITY HEALTH CARE SUPPLIES, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CARE SUPPLIES, INC.
Other - Org Name:COMMUNITY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:CLAYPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-228-3081
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-0455
Mailing Address - Country:US
Mailing Address - Phone:276-228-3081
Mailing Address - Fax:276-228-8636
Practice Address - Street 1:530 W RIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1042
Practice Address - Country:US
Practice Address - Phone:276-228-3081
Practice Address - Fax:276-228-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206008998332B00000X
VA0207008453332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146260OtherANTHEM BC/BS
VA4241780001Medicare ID - Type Unspecified