Provider Demographics
NPI:1437485042
Name:HOME MEDICAL DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:HOME MEDICAL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-786-1588
Mailing Address - Street 1:168 COLUMBIA CLUB DR W
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9458
Mailing Address - Country:US
Mailing Address - Phone:803-786-1588
Mailing Address - Fax:803-735-0682
Practice Address - Street 1:168 COLUMBIA CLUB DR W
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-9458
Practice Address - Country:US
Practice Address - Phone:803-786-1588
Practice Address - Fax:803-735-0682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty