Healthcare Provider Details

I. General information

NPI: 1326037102
Provider Name (Legal Business Name): HOMETOWN MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 04/15/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MEDICAL LANE
WHITLEY CITY KY
42653
US

IV. Provider business mailing address

PO BOX 1180
WHITLEY CITY KY
42653-1180
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-1551
  • Fax: 606-376-4444
Mailing address:
  • Phone: 606-376-1551
  • Fax: 606-376-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number10365
License Number State

VIII. Authorized Official

Name: JERRY L PENNINGTON
Title or Position: PRESIDENT
Credential:
Phone: 606-376-1551