Provider Demographics
NPI:1811230816
Name:HILLSIDE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:HILLSIDE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ARNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-435-0676
Mailing Address - Street 1:3994 BELUGA CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7712
Mailing Address - Country:US
Mailing Address - Phone:907-435-0676
Mailing Address - Fax:907-435-0676
Practice Address - Street 1:3994 BELUGA CIR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7712
Practice Address - Country:US
Practice Address - Phone:907-435-0676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK986050332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies