Provider Demographics
NPI:1669595492
Name:HOME MEDICAL, INC
Entity type:Organization
Organization Name:HOME MEDICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:870-534-4944
Mailing Address - Street 1:7197 SHERIDAN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3261
Mailing Address - Country:US
Mailing Address - Phone:870-534-4944
Mailing Address - Fax:870-534-9199
Practice Address - Street 1:3511 SE J ST STE 3
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5489
Practice Address - Country:US
Practice Address - Phone:479-464-5987
Practice Address - Fax:479-464-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR033202332BC3200X
AR1022332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158764716Medicaid
AR159100737Medicaid
AR158764716Medicaid