Provider Demographics
NPI:1689663924
Name:HYDES HOME HEALTH MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:HYDES HOME HEALTH MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-625-6334
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-0003
Mailing Address - Country:US
Mailing Address - Phone:205-625-6334
Mailing Address - Fax:
Practice Address - Street 1:210 2ND ST S
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2110
Practice Address - Country:US
Practice Address - Phone:205-625-6334
Practice Address - Fax:205-625-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL277332B00000X, 332BP3500X, 335E00000X
AL900051332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051090Medicaid
AL57852OtherBCBS PROVIDER ID
AL000051090Medicaid