Provider Demographics
NPI:1518097682
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:MR
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 1:400 RODI RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4519
Mailing Address - Country:US
Mailing Address - Phone:412-371-0661
Mailing Address - Fax:412-242-4489
Practice Address - Street 1:400 RODI RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4519
Practice Address - Country:US
Practice Address - Phone:412-371-0661
Practice Address - Fax:412-242-4489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC HEALTHCARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005681200003Medicaid
PA0005681200003Medicaid