Healthcare Provider Details

I. General information

NPI: 1750389110
Provider Name (Legal Business Name): COMMUNITY MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BURKESVILLE ST
COLUMBIA KY
42728-1655
US

IV. Provider business mailing address

PO BOX 987
COLUMBIA KY
42728-0987
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-0750
  • Fax:
Mailing address:
  • Phone: 270-384-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SHARON STACEY WILSON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 270-384-0750