MEDICARE: COUCH HOME MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013247303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUCH HOME MEDICAL

Provider Business Mailing Address
First Line	:	PO BOX 1053
Second Line	:	16610 RUSSELL STREET
City	:	SAINT PAUL
State	:	VA
Zip	:	24283-1053
Country	:	US
Telephone Number	:	276-762-0146
Fax Number	:	276-762-0146

Provider Business Practice Location Address
First Line	:	16610 RUSSELL STREET
Second Line	:	SUITE 2
City	:	SAINT PAUL
State	:	VA
Zip	:	24283-1053
Country	:	US
Telephone Number	:	276-762-0146
Fax Number	:	276-762-0146

Authorized Official
Title or Position	:	OWNER/VICE PRESIDENT
Name	:	PAMELA DARLENE COUCH
Credential	:
Telephone Number	:	276-762-0146

Provider Enumeration Date	:	01/08/2010
Last Update Date	:	03/02/2011

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Directions to “COUCH HOME MEDICAL ” Practice Location

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