Provider Demographics
NPI:1710960059
Name:HOME CARE OF FIDELITY
Entity Type:Organization
Organization Name:HOME CARE OF FIDELITY
Other - Org Name:FIDELITY HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:OBLEPIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-365-9121
Mailing Address - Street 1:22815 PARKWALK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4451
Mailing Address - Country:US
Mailing Address - Phone:713-365-9121
Mailing Address - Fax:713-365-9120
Practice Address - Street 1:4615 SOUTHWEST FWY
Practice Address - Street 2:STE 479
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7108
Practice Address - Country:US
Practice Address - Phone:713-365-9121
Practice Address - Fax:713-365-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016448501Medicaid
TX4985680001Medicare NSC