Provider Demographics
NPI:1700879194
Name:HOMEBOUND MEDICAL SUPPLY CO
Entity Type:Organization
Organization Name:HOMEBOUND MEDICAL SUPPLY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:PIGFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-285-4410
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:615 E SOUTHERLAND ST
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-0070
Mailing Address - Country:US
Mailing Address - Phone:910-285-4410
Mailing Address - Fax:910-285-7505
Practice Address - Street 1:615 E SOUTHERLAND ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-0070
Practice Address - Country:US
Practice Address - Phone:910-285-4410
Practice Address - Fax:910-285-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00062332B00000X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0495WOtherBCBSNC
NC7700037Medicaid
NC0495WOtherBCBSNC