Healthcare Provider Details

I. General information

NPI: 1043489396
Provider Name (Legal Business Name): CLOUD MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N MAIN ST
CORBIN KY
40701-1452
US

IV. Provider business mailing address

208 N MAIN ST
CORBIN KY
40701-1452
US

V. Phone/Fax

Practice location:
  • Phone: 606-258-8600
  • Fax: 606-258-8333
Mailing address:
  • Phone: 606-258-8600
  • Fax: 606-258-8333

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. MARK HINKLE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 606-258-8600