Healthcare Provider Details

I. General information

NPI: 1598895518
Provider Name (Legal Business Name): ELLIS HOME OXYGEN & MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N MAIN ST
MARION VA
24354-4117
US

IV. Provider business mailing address

220 W GERMANTOWN PIKE STE 250
PLYMOUTH MEETING PA
19462-1437
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-6868
  • Fax: 276-783-3357
Mailing address:
  • Phone: 610-630-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0206008222
License Number StateVA

VIII. Authorized Official

Name: STEPHEN GRIGGS
Title or Position: PRESIDENT
Credential:
Phone: 407-206-0040