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General NPI Number Information
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NPI Number | 1164830667
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Entity Type | Organization
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Legal Business Name | HOMETOWN MEDICAL SUPPLY
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 488 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2633
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Country | US
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Telephone | 636-203-5883
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Fax | 800-522-3601
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Provider Business Mailing Address
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Address Line | 488 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2633
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Country | US
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Telephone | 636-203-5883
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Fax | 800-522-3601
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Authorized Official
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Title or Position | OWNER
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Name | MR. NATHAN BLAIR
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Credential |
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Telephone | 636-203-5883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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