Healthcare Provider Details

I. General information

NPI: 1154313914
Provider Name (Legal Business Name): FIELDS MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 BLACKLOG ROAD
INEZ KY
41224-0000
US

IV. Provider business mailing address

2138 BLACKLOG ROAD
INEZ KY
41224-0000
US

V. Phone/Fax

Practice location:
  • Phone: 606-298-3674
  • Fax: 606-298-0724
Mailing address:
  • Phone: 606-298-3674
  • Fax: 606-298-0724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number083898
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number083898
License Number StateKY

VIII. Authorized Official

Name: MRS. BARBARA KIRK
Title or Position: OWNER
Credential:
Phone: 606-298-3674