Provider Demographics
NPI:1750323598
Name:GEORGETOWN HOME MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:GEORGETOWN HOME MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HETTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-942-8582
Mailing Address - Street 1:100 RIVER HILLS DR # 106
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3681
Mailing Address - Country:US
Mailing Address - Phone:512-763-1020
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER HILLS DR # 106
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3681
Practice Address - Country:US
Practice Address - Phone:512-763-1020
Practice Address - Fax:512-763-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0045992332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017400501Medicaid
TX3973530004Medicare ID - Type UnspecifiedBELTON LOCATION
TX3973530001Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX3973530002Medicare ID - Type UnspecifiedBURNET LOCATION