Provider Demographics
NPI:1598812984
Name:MERCHANT HOME MEDICAL SERVICES,LLC
Entity Type:Organization
Organization Name:MERCHANT HOME MEDICAL SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN LEWIS
Authorized Official - Last Name:DENMARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-931-4211
Mailing Address - Street 1:PO BOX 1167
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-1167
Mailing Address - Country:US
Mailing Address - Phone:229-257-0024
Mailing Address - Fax:229-247-8200
Practice Address - Street 1:105 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5508
Practice Address - Country:US
Practice Address - Phone:229-257-0024
Practice Address - Fax:229-247-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
GAPHRE00858353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000912513AMedicaid
GAPHRE008535OtherRETAIL PHARMACY
GA000912513AMedicaid