Provider Demographics
NPI:1912106352
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:706-629-1050
Mailing Address - Street 1:609 N WALL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1996
Mailing Address - Country:US
Mailing Address - Phone:706-629-1050
Mailing Address - Fax:706-629-1090
Practice Address - Street 1:609 N WALL ST STE 2
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1996
Practice Address - Country:US
Practice Address - Phone:706-629-1050
Practice Address - Fax:706-629-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4940900003Medicare NSC