Provider Demographics
NPI:1740439207
Name:HILL'S GENERAL STORE, INC.
Entity type:Organization
Organization Name:HILL'S GENERAL STORE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:276-755-3412
Mailing Address - Street 1:13763 FANCY GAP HWY
Mailing Address - Street 2:
Mailing Address - City:CANA
Mailing Address - State:VA
Mailing Address - Zip Code:24317-3517
Mailing Address - Country:US
Mailing Address - Phone:276-755-3412
Mailing Address - Fax:276-755-4702
Practice Address - Street 1:13763 FANCY GAP HWY
Practice Address - Street 2:
Practice Address - City:CANA
Practice Address - State:VA
Practice Address - Zip Code:24317-3517
Practice Address - Country:US
Practice Address - Phone:276-755-3412
Practice Address - Fax:276-755-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPED2796332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier