Provider Demographics
NPI:1518023837
Name:HOMETOWN OXYGEN PITTSBURGH LLC
Entity Type:Organization
Organization Name:HOMETOWN OXYGEN PITTSBURGH LLC
Other - Org Name:DYNAMIC HEALTHCARE SERVICES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRABKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-657-2100
Mailing Address - Street 1:22631 ROUTE 68
Mailing Address - Street 2:SUITE 480
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-4068
Mailing Address - Country:US
Mailing Address - Phone:814-226-6028
Mailing Address - Fax:814-226-6029
Practice Address - Street 1:660 LONGVIEW RD STE E
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT CITY
Practice Address - State:PA
Practice Address - Zip Code:16224-1802
Practice Address - Country:US
Practice Address - Phone:814-226-6028
Practice Address - Fax:814-226-6029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC HEALTHCARE SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000007900332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019419860005Medicaid
PA1019419860005Medicaid
PA28682OtherWRIGHT AND FILIPPIS
PA5435930001OtherMEDICARE PTAN