Provider Demographics
NPI:1639207996
Name:HATCHETT HOME MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:HATCHETT HOME MEDICAL EQUIPMENT INC
Other - Org Name:PARK AVENUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER AND MGR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-5156
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0039
Mailing Address - Country:US
Mailing Address - Phone:270-651-5156
Mailing Address - Fax:
Practice Address - Street 1:131 PARK AVE
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3226
Practice Address - Country:US
Practice Address - Phone:270-651-5156
Practice Address - Fax:270-651-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP025403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028683OtherPK
KY90030057Medicaid
KY54029129Medicaid
0385820001Medicare NSC