Healthcare Provider Details

I. General information

NPI: 1598812984
Provider Name (Legal Business Name): MERCHANT HOME MEDICAL SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W CENTRAL AVE
VALDOSTA GA
31601-5508
US

IV. Provider business mailing address

PO BOX 1167
VALDOSTA GA
31603-1167
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-0024
  • Fax: 229-247-8200
Mailing address:
  • Phone: 229-257-0024
  • Fax: 229-247-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE0085835
License Number StateGA

VIII. Authorized Official

Name: STACY LYNN LEWIS DENMARK
Title or Position: OWNER
Credential:
Phone: 540-931-4211