Healthcare Provider Details

I. General information

NPI: 1700879194
Provider Name (Legal Business Name): HOMEBOUND MEDICAL SUPPLY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E SOUTHERLAND ST
WALLACE NC
28466-0070
US

IV. Provider business mailing address

PO BOX 70 615 E SOUTHERLAND ST
WALLACE NC
28466-0070
US

V. Phone/Fax

Practice location:
  • Phone: 910-285-4410
  • Fax: 910-285-7505
Mailing address:
  • Phone: 910-285-4410
  • Fax: 910-285-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00062
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number00062
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number00062
License Number StateNC

VIII. Authorized Official

Name: MR. HORACE VERNON PIGFORD JR.
Title or Position: PRESIDENT
Credential:
Phone: 910-285-4410