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General NPI Number Information
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NPI Number | 1225007685
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Entity Type | Organization
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Legal Business Name | HOMETOWN MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 516 JOEL BLVD UNIT D
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-4305
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Country | US
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Telephone | 239-369-1425
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Fax | 239-369-5927
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Provider Business Mailing Address
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Address Line | 516 JOEL BLVD UNIT D
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-4305
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Country | US
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Telephone | 239-369-1425
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Fax | 239-369-5927
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS JESICA SANTANA COLON
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Credential |
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Telephone | 239-369-1425
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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 | FL
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