Healthcare Provider Details

I. General information

NPI: 1134115025
Provider Name (Legal Business Name): HIGH PLAINS HOME MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N POLK ST
AMARILLO TX
79107-5232
US

IV. Provider business mailing address

414 N POLK ST
AMARILLO TX
79107-5232
US

V. Phone/Fax

Practice location:
  • Phone: 806-457-1080
  • Fax: 806-457-1041
Mailing address:
  • Phone: 806-457-1080
  • Fax: 806-457-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0045003
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0045003
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL TODD MAYNARD
Title or Position: CO-OWNER
Credential: RRT
Phone: 806-457-1080