Provider Demographics
NPI:1780629402
Name:HOM-MED, INC.
Entity Type:Organization
Organization Name:HOM-MED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FAROOQ
Authorized Official - Middle Name:A
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-321-1605
Mailing Address - Street 1:PO BOX 28437
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-0437
Mailing Address - Country:US
Mailing Address - Phone:216-321-1605
Mailing Address - Fax:216-321-6727
Practice Address - Street 1:1908 S TAYLOR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2104
Practice Address - Country:US
Practice Address - Phone:216-321-1605
Practice Address - Fax:216-321-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0583631Medicaid
00000241891OtherHIGHMARK BC&BS
0852760OtherAETNA HEALTH INS
000000155680OtherANTHEM BC&BS
000000155680OtherANTHEM BC&BS
=========003OtherMEDICAL MUTUAL OF OHIO