=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275739914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE MEDICAL EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 E GREENE ST
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31064-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-596-1646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 626
-----------------------------------------------------
City | REX
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30273-0626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHARLIE GARRETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-596-1646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------