Healthcare Provider Details

I. General information

NPI: 1174846331
Provider Name (Legal Business Name): HOMETOWN OXYGEN WINSTON SALEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 PETERS CREEK PKWY
WINSTON SALEM NC
27103-4552
US

IV. Provider business mailing address

41 SPRING ST. SUITE 103
NEW PROVIDENCE NJ
07974
US

V. Phone/Fax

Practice location:
  • Phone: 336-723-1027
  • Fax: 704-347-4978
Mailing address:
  • Phone: 336-723-1027
  • Fax: 336-723-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS VOORHEES
Title or Position: CEO
Credential:
Phone: 732-692-2747