ABC HOME MEDICAL SUPPLY, INC.

Provider Demographics

• NPI: 1477534717
• Name: ABC HOME MEDICAL SUPPLY, INC.
• Entity Type: Organization
• Organization Name: ABC HOME MEDICAL SUPPLY, INC.
• Authorized Official - Title/Position: PRESIDENT AND DIRECTOR
• Authorized Official - First Name: EMILY
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: VESTAL
• Authorized Official - Phone: 866-897-8588
• Mailing Address - Street 1: PO BOX 674553
• Mailing Address - City: DETROIT
• Mailing Address - State: MI
• Mailing Address - Zip Code: 48267-4553
• Mailing Address - Country: US
• Mailing Address - Phone: 972-279-9090
• Mailing Address - Fax: 772-212-4904
• Practice Address - Street 1: 1720 N GREENVILLE AVE
• Practice Address - City: RICHARDSON
• Practice Address - State: TX
• Practice Address - Zip Code: 75081
• Practice Address - Country: US
• Practice Address - Phone: 972-279-9090
• Practice Address - Fax: 772-212-4904
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-11-11
• Last Update Date: 2023-05-16

Provider Licenses

State	License ID	Taxonomies
TX	1000858	332B00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MS	07956061	Medicaid
LA	1333042	Medicaid
IN	1477534717	Medicaid
NV	1477534717	Medicaid
ME	1477534717	Medicaid
OH	2622746	Medicaid
AZ	40637	Medicaid
TX	531312	Other	BLUE CROSS BLUE SHIELD
NM	69584567	Medicaid
UT	1014147	Medicaid
PA	1015431740004	Medicaid
WY	135141900	Medicaid
TN	1523283	Medicaid
TX	1598120-01	Medicaid
TX	198202415247	Other	HUMANA
ID	808413200	Medicaid
MN	1477534717	Medicaid
TX	3923916	Other	CIGNA
MD	413700100	Medicaid
MI	5338606	Medicaid
DC	095735900	Medicaid
MT	1477534717	Medicaid
AL	1477534717	Medicaid
WA	9059387	Medicaid
GA	982216402C	Medicaid
TX	1598120-03	Medicaid
KY	7100202210	Medicaid
VA	1477534717	Medicaid
MO	1477534717	Medicaid
NE	10025992900	Medicaid
SD	1477534717	Medicaid
IA	1477534717	Medicaid
AR	158660716	Medicaid
OK	200061970A	Medicaid
CO	31389015	Medicaid
WI	41571000	Medicaid
CA	XDME03168	Medicaid
MO	1477534717	Medicaid
NM	69584567	Medicaid