Provider Demographics
NPI:1598009821
Name:AFFINITY HOME MEDICAL INC.
Entity Type:Organization
Organization Name:AFFINITY HOME MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:O'GWYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-947-2002
Mailing Address - Street 1:21862 STATE HIGHWAY 59 S
Mailing Address - Street 2:SUITE G
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-6711
Mailing Address - Country:US
Mailing Address - Phone:251-947-2002
Mailing Address - Fax:251-947-3503
Practice Address - Street 1:21862 STATE HIGHWAY 59 S
Practice Address - Street 2:SUITE G
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-6711
Practice Address - Country:US
Practice Address - Phone:251-947-2002
Practice Address - Fax:251-947-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2013-008888332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies