Healthcare Provider Details

I. General information

NPI: 1790780781
Provider Name (Legal Business Name): HOME MEDICAL SUPPLY OF POPLAR BLUFF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SUNSET DR
POPLAR BLUFF MO
63901-2820
US

IV. Provider business mailing address

1901 SUNSET DR
POPLAR BLUFF MO
63901-2820
US

V. Phone/Fax

Practice location:
  • Phone: 800-682-5510
  • Fax: 573-686-5510
Mailing address:
  • Phone: 800-682-5510
  • Fax: 573-686-6846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO

VIII. Authorized Official

Name: MYLYNN GARGAC
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 800-682-5510