Provider Demographics
NPI:1790962256
Name:MILLEN HOME CARE MEDICAL, INC
Entity Type:Organization
Organization Name:MILLEN HOME CARE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEYWOOD
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-982-1999
Mailing Address - Street 1:530 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MILLEN
Mailing Address - State:GA
Mailing Address - Zip Code:30442-1602
Mailing Address - Country:US
Mailing Address - Phone:478-982-1999
Mailing Address - Fax:478-982-0031
Practice Address - Street 1:530 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1602
Practice Address - Country:US
Practice Address - Phone:478-982-1999
Practice Address - Fax:478-982-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6136860001Medicare NSC