Provider Demographics
NPI:1023136785
Name:BROADWAY HOME MEDICAL, INC
Entity type:Organization
Organization Name:BROADWAY HOME MEDICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-264-8600
Mailing Address - Street 1:808 S. HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3004
Mailing Address - Country:US
Mailing Address - Phone:316-264-8600
Mailing Address - Fax:316-264-1999
Practice Address - Street 1:356 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2820
Practice Address - Country:US
Practice Address - Phone:316-264-8600
Practice Address - Fax:316-264-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS047998OtherBLUE CROSS BLUE SHIELD
KS100211360AMedicaid
KS100211360BMedicaid
KS412640OtherFIRSTGUARD
KS8017OtherPREFERRED HEALTH SERVICES
KS047998OtherBLUE CROSS BLUE SHIELD