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General NPI Number Information
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NPI Number | 1386778595
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Entity Type | Organization
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Legal Business Name | IV AT HOME INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 119 WARD ST S
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City | SENATOBIA
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State | MS
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Zip | 38668-2638
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Country | US
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Telephone | 662-562-7007
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Fax | 662-562-8009
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Provider Business Mailing Address
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Address Line | 119 WARD ST S
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City | SENATOBIA
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State | MS
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Zip | 38668-2638
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Country | US
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Telephone | 662-562-7007
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Fax | 662-562-8009
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT E GRISHAM
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Credential |
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Telephone | 662-562-7007
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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 | 0409111.1
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License Number State | MS
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