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General NPI Number Information
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NPI Number | 1255442844
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Entity Type | Organization
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Legal Business Name | ELUMINA MEDICAL SUPPLIES, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 1220 GAY ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3460
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Country | US
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Telephone | 740-353-0202
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Fax | 740-353-2091
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Provider Business Mailing Address
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Address Line | PO BOX 410
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City | PORTSMOUTH
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State | OH
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Zip | 45662-0410
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Country | US
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Telephone | 740-353-0202
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Fax | 740-353-2091
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Authorized Official
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Title or Position | SVP OF TREASURY & REGULATORY MANAGE
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Name | KIM FERGUSON
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Credential |
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Telephone | 740-352-8113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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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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