Healthcare Provider Details

I. General information

NPI: 1265484653
Provider Name (Legal Business Name): LONG TERM MEDICAL SUPPLY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E JEFFERSON
BLOOMFIELD IA
52537-1601
US

IV. Provider business mailing address

115 2ND AVE NW
HAMPTON IA
50441-1723
US

V. Phone/Fax

Practice location:
  • Phone: 641-664-1411
  • Fax: 641-664-1489
Mailing address:
  • Phone: 641-456-2885
  • Fax: 641-456-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TODD R ALLBEE
Title or Position: HR
Credential:
Phone: 641-456-5636