Healthcare Provider Details

I. General information

NPI: 1124176359
Provider Name (Legal Business Name): FAMILY HOME MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 DEWEY DRIVE SUITE 106A
FAIR OAKS CA
95628-3130
US

IV. Provider business mailing address

PO BOX 2597
MARYSVILLE CA
95901-0009
US

V. Phone/Fax

Practice location:
  • Phone: 916-925-7009
  • Fax: 888-577-6924
Mailing address:
  • Phone: 916-925-7009
  • Fax: 888-577-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number23663
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number59510
License Number StateCA

VIII. Authorized Official

Name: SCOTT THOMAS FIX
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 916-925-7009