Healthcare Provider Details

I. General information

NPI: 1881686566
Provider Name (Legal Business Name): MEDICAL PARK HOME EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 10TH ST
GREAT BEND KS
67530-3436
US

IV. Provider business mailing address

4010 10TH ST
GREAT BEND KS
67530-3436
US

V. Phone/Fax

Practice location:
  • Phone: 620-793-7828
  • Fax:
Mailing address:
  • Phone: 620-793-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. A JEFFREY DENTON
Title or Position: PRESIDENT
Credential: RPH
Phone: 620-793-7828