Provider Demographics
NPI:1508195587
Name:HOME MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:HOME MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-266-0092
Mailing Address - Street 1:2500 CONSTANT COMMENT PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6323
Mailing Address - Country:US
Mailing Address - Phone:502-349-0402
Mailing Address - Fax:502-349-0412
Practice Address - Street 1:118 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9093
Practice Address - Country:US
Practice Address - Phone:502-349-0402
Practice Address - Fax:502-349-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies