Provider Demographics
NPI:1578525861
Name:A. M. HOME DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:A. M. HOME DIAGNOSTICS, INC.
Other - Org Name:HEALTHLINE SEYMOUR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-691-6100
Mailing Address - Street 1:PO BOX 4847
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0847
Mailing Address - Country:US
Mailing Address - Phone:940-691-6100
Mailing Address - Fax:940-691-0757
Practice Address - Street 1:112 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-2557
Practice Address - Country:US
Practice Address - Phone:940-888-2255
Practice Address - Fax:940-888-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX0039295332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0485110002Medicare ID - Type Unspecified