Provider Demographics
NPI:1962817874
Name:P & R HOME IV SERVICE, INC.
Entity Type:Organization
Organization Name:P & R HOME IV SERVICE, INC.
Other - Org Name:P & R MEDICAL CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-587-7670
Mailing Address - Street 1:16937 DEFIANCE TRL
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-8619
Mailing Address - Country:US
Mailing Address - Phone:800-587-7670
Mailing Address - Fax:419-587-2030
Practice Address - Street 1:1113 S. SHANNON STREET
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-8619
Practice Address - Country:US
Practice Address - Phone:419-238-9828
Practice Address - Fax:419-238-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER.22207332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1124131925OtherMEDICARE NPI
OH0631301Medicaid
IN201007250AMedicaid
IN201007250AMedicaid