Provider Demographics
NPI:1013278399
Name:BARBARA J MANTHA
Entity Type:Organization
Organization Name:BARBARA J MANTHA
Other - Org Name:HOME MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:MANTHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-265-5581
Mailing Address - Street 1:PO BOX 1173
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365
Mailing Address - Country:US
Mailing Address - Phone:541-265-5581
Mailing Address - Fax:541-265-5264
Practice Address - Street 1:644 SW COAST HWY STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5051
Practice Address - Country:US
Practice Address - Phone:541-265-5581
Practice Address - Fax:541-265-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNPC-0001856332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6695420001OtherMEDICARE PTAN
OR500646786Medicaid