Healthcare Provider Details

I. General information

NPI: 1194756361
Provider Name (Legal Business Name): STULTZ HOME MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 ASHLAND RD
GREENUP KY
41144-1207
US

IV. Provider business mailing address

1615 ASHLAND RD
GREENUP KY
41144-1207
US

V. Phone/Fax

Practice location:
  • Phone: 606-831-1129
  • Fax: 606-473-7174
Mailing address:
  • Phone: 606-473-7346
  • Fax: 606-473-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRAD STULTZ
Title or Position: PRESIDENT
Credential:
Phone: 606-473-7346