Provider Demographics
NPI:1013247303
Name:COUCH HOME MEDICAL
Entity Type:Organization
Organization Name:COUCH HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-762-0146
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:16610 RUSSELL STREET
Mailing Address - City:SAINT PAUL
Mailing Address - State:VA
Mailing Address - Zip Code:24283-1053
Mailing Address - Country:US
Mailing Address - Phone:276-762-0146
Mailing Address - Fax:276-762-0146
Practice Address - Street 1:16610 RUSSELL STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT PAUL
Practice Address - State:VA
Practice Address - Zip Code:24283-1053
Practice Address - Country:US
Practice Address - Phone:276-762-0146
Practice Address - Fax:276-762-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013247303Medicaid
VA1013247303Medicaid