Provider Demographics
NPI:1417140435
Name:UPLAND HILLS HOMETOWN MEDICAL EQUIP
Entity Type:Organization
Organization Name:UPLAND HILLS HOMETOWN MEDICAL EQUIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILKELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-348-6250
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-0637
Mailing Address - Country:US
Mailing Address - Phone:608-348-6250
Mailing Address - Fax:608-348-6631
Practice Address - Street 1:490 E BUSINESS HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3768
Practice Address - Country:US
Practice Address - Phone:608-348-6250
Practice Address - Fax:608-348-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41568700Medicaid
WI41568700Medicaid