Provider Demographics
NPI:1881769297
Name:SOUTHERN TIER HOME MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:SOUTHERN TIER HOME MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:NOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-593-3050
Mailing Address - Street 1:67 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1249
Mailing Address - Country:US
Mailing Address - Phone:585-593-3050
Mailing Address - Fax:585-593-3051
Practice Address - Street 1:67 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1249
Practice Address - Country:US
Practice Address - Phone:585-593-3050
Practice Address - Fax:585-593-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030021601OtherUNIVERA
NY000551026001OtherBLUE CROSS OF WESTERN NY
NY00888459Medicaid
NY000551026001OtherBLUE CROSS OF WESTERN NY