Provider Demographics
NPI:1528035086
Name:HOME OXYGEN & MEDICAL EQUIPMENT OF VA INC.
Entity Type:Organization
Organization Name:HOME OXYGEN & MEDICAL EQUIPMENT OF VA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY/ OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMOAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-822-1300
Mailing Address - Street 1:4972A RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5630
Mailing Address - Country:US
Mailing Address - Phone:434-822-1300
Mailing Address - Fax:434-822-1303
Practice Address - Street 1:4972A RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5630
Practice Address - Country:US
Practice Address - Phone:434-822-1300
Practice Address - Fax:434-822-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206008350332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
380507OtherANTHEM CROSSOVER
46177OtherSENTARA
NC7701329Medicaid
380507OtherANTHEM PRIMARY
VA009118594Medicaid
=========OtherTAX ID
46177OtherSENTARA
VA009118594Medicaid