Healthcare Provider Details

I. General information

NPI: 1821411497
Provider Name (Legal Business Name): HOTASAN MEDICAL SUPPLIERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2014
Last Update Date: 02/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 E HARRY ST
WICHITA KS
67207-2962
US

IV. Provider business mailing address

6602 E HARRY ST
WICHITA KS
67207-2962
US

V. Phone/Fax

Practice location:
  • Phone: 316-243-1872
  • Fax:
Mailing address:
  • Phone: 316-516-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7669047
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL ATOH ACHU
Title or Position: MARKETING AND BUSINESS DEVELOPMENT
Credential:
Phone: 316-516-1633