Provider Demographics
NPI:1770513764
Name:BR HOME MEDICAL SUPPLY
Entity type:Organization
Organization Name:BR HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-761-8870
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1528
Mailing Address - Country:US
Mailing Address - Phone:787-761-8870
Mailing Address - Fax:787-761-9516
Practice Address - Street 1:EXPRESO TRUJILLO ALTO CARR 850 KM 4.2
Practice Address - Street 2:BARRIO LAS CUEVAS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-761-8870
Practice Address - Fax:787-761-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4342660001Medicare NSC