Provider Demographics
NPI:1962664391
Name:SORRELL HOME MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:SORRELL HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:SORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-570-9835
Mailing Address - Street 1:208 W PLEASANT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-2421
Mailing Address - Country:US
Mailing Address - Phone:502-570-9835
Mailing Address - Fax:
Practice Address - Street 1:101 EASTSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8763
Practice Address - Country:US
Practice Address - Phone:502-570-9835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0634332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90005901Medicaid
KY4657790002Medicare NSC