Provider Demographics
NPI:1245672021
Name:MIDSTREAM HOME UROLOGICAL
Entity type:Organization
Organization Name:MIDSTREAM HOME UROLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MARNHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:502-299-8042
Mailing Address - Street 1:3416 HANOVER CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4326
Mailing Address - Country:US
Mailing Address - Phone:502-299-8042
Mailing Address - Fax:
Practice Address - Street 1:3416 HANOVER CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4326
Practice Address - Country:US
Practice Address - Phone:502-299-8042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies