Provider Demographics
NPI:1689963415
Name:UNITY HOME MEDICAL, LLC
Entity Type:Organization
Organization Name:UNITY HOME MEDICAL, LLC
Other - Org Name:INTEGRITY HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-759-1919
Mailing Address - Street 1:9087 POPLAR AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7846
Mailing Address - Country:US
Mailing Address - Phone:901-759-1919
Mailing Address - Fax:901-759-4119
Practice Address - Street 1:690 S MENDENHALL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5213
Practice Address - Country:US
Practice Address - Phone:901-440-8339
Practice Address - Fax:901-759-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07332/11.1332B00000X
TN1048332B00000X
TN3542332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525885Medicaid
MS6028970001OtherPTAN FOR MISSISSIPPI OPERATION