Healthcare Provider Details

I. General information

NPI: 1013247303
Provider Name (Legal Business Name): COUCH HOME MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16610 RUSSELL STREET SUITE 2
SAINT PAUL VA
24283-1053
US

IV. Provider business mailing address

PO BOX 1053 16610 RUSSELL STREET
SAINT PAUL VA
24283-1053
US

V. Phone/Fax

Practice location:
  • Phone: 276-762-0146
  • Fax: 276-762-0146
Mailing address:
  • Phone: 276-762-0146
  • Fax: 276-762-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAMELA DARLENE COUCH
Title or Position: OWNER/VICE PRESIDENT
Credential:
Phone: 276-762-0146