Provider Demographics
NPI:1841499282
Name:OUTREACH MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:OUTREACH MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:BARTHOLOMEW
Authorized Official - Last Name:EKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-313-0778
Mailing Address - Street 1:17 FELTON PL
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2153
Mailing Address - Country:US
Mailing Address - Phone:423-313-0778
Mailing Address - Fax:
Practice Address - Street 1:17 FELTON PL
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2153
Practice Address - Country:US
Practice Address - Phone:423-313-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies