Provider Demographics
NPI:1740215672
Name:PENNYRILE HOME MEDICAL INC
Entity Type:Organization
Organization Name:PENNYRILE HOME MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:CHESNUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-885-2500
Mailing Address - Street 1:7654 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8779
Mailing Address - Country:US
Mailing Address - Phone:270-885-2500
Mailing Address - Fax:270-889-9431
Practice Address - Street 1:7654 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8779
Practice Address - Country:US
Practice Address - Phone:270-885-2500
Practice Address - Fax:270-889-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100110680Medicaid
TN1522776Medicaid
KY0494410002Medicare ID - Type UnspecifiedPROVIDER NUMBER
KY0494410002Medicare NSC