=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235224338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME MED, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1302 SUNSET BLVD
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169-5914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-791-3739
-----------------------------------------------------
Fax | 803-791-3712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1302 SUNSET BLVD
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169-5914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-791-3739
-----------------------------------------------------
Fax | 803-791-3712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. LYNN E CONNELLY
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 803-791-3739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------