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General NPI Number Information
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NPI Number | 1265700447
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Entity Type | Organization
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Legal Business Name | ELLIS HOME OXYGEN & MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 329A CUMMINGS ST
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City | ABINGDON
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State | VA
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Zip | 24210-3207
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Country | US
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Telephone | 276-619-0060
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Fax | 276-619-0061
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Provider Business Mailing Address
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Address Line | 329A CUMMINGS ST
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City | ABINGDON
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State | VA
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Zip | 24210-3207
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Country | US
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Telephone | 276-619-0060
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Fax | 276-619-0061
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Authorized Official
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Title or Position | ASSISTANT TO THE PRESIDENT
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Name | MR. PAMELA W ELLIS
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Credential | RN/WHNP-BC
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Telephone | 276-619-0060
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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 | 0206009641
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License Number State | VA
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