Provider Demographics
NPI:1851335475
Name:HOMES OXYGEN MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:HOMES OXYGEN MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:PENDERGRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-365-2228
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-0358
Mailing Address - Country:US
Mailing Address - Phone:606-365-2228
Mailing Address - Fax:606-365-0098
Practice Address - Street 1:3025 US HIGHWAY 150 W
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-9640
Practice Address - Country:US
Practice Address - Phone:606-365-2228
Practice Address - Fax:606-365-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000497142OtherANTHEM BLUE CROSS
KY90013707Medicaid
KY5707220001Medicare NSC