Provider Demographics
NPI:1598777161
Name:PCH HOME MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:PCH HOME MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-694-2479
Mailing Address - Street 1:835 WOODLAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1586
Mailing Address - Country:US
Mailing Address - Phone:276-694-2479
Mailing Address - Fax:276-694-3833
Practice Address - Street 1:835 WOODLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1586
Practice Address - Country:US
Practice Address - Phone:276-694-2479
Practice Address - Fax:276-694-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009325332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000197677OtherANTHEM
VATRICAREOther203652687 24171 0000
VA5570420001Medicare ID - Type Unspecified