Provider Demographics
NPI:1912179508
Name:WILLIAM JEREMY HARVEY
Entity Type:Organization
Organization Name:WILLIAM JEREMY HARVEY
Other - Org Name:TRI-STATE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-472-3335
Mailing Address - Street 1:1409 US ROUTE 35 E
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2231
Mailing Address - Country:US
Mailing Address - Phone:937-472-3335
Mailing Address - Fax:937-472-3332
Practice Address - Street 1:1409 US ROUTE 35 E
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-2231
Practice Address - Country:US
Practice Address - Phone:937-472-3335
Practice Address - Fax:937-472-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER.22478332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200897400AMedicaid
OH2834133Medicaid
OH6117050001Medicare NSC