Healthcare Provider Details

I. General information

NPI: 1699773143
Provider Name (Legal Business Name): YOUR HOME TOWN MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date: 02/29/2012
Reactivation Date: 03/22/2016

III. Provider practice location address

1615 N WALNUT ST
PITTSBURG KS
66762-3049
US

IV. Provider business mailing address

1615 N WALNUT ST
PITTSBURG KS
66762-3049
US

V. Phone/Fax

Practice location:
  • Phone: 620-670-6080
  • Fax: 620-223-2374
Mailing address:
  • Phone: 620-670-6080
  • Fax: 620-223-2374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number16103515
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number16103515
License Number StateKS

VIII. Authorized Official

Name: MR. GLEN A PEARSON JR.
Title or Position: OWNER
Credential:
Phone: 620-670-6080