Provider Demographics
NPI:1437258217
Name:ST. ANTHONY HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:ST. ANTHONY HOME MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAMPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-877-1411
Mailing Address - Street 1:301 W. HOMER STREET
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360
Mailing Address - Country:US
Mailing Address - Phone:219-861-8469
Mailing Address - Fax:219-877-1079
Practice Address - Street 1:301 W. HOMER STREET
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-861-8469
Practice Address - Fax:219-877-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0527450002Medicare ID - Type UnspecifiedAPPLICATION PENDING