=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457423634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMESIDE HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 04/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1315 US 68 SOUTHGATE PLAZA
-----------------------------------------------------
City | MAYSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41056-9132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-563-9400
-----------------------------------------------------
Fax | 606-564-4144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1315 US 68
-----------------------------------------------------
City | MAYSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41056-9132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-563-9400
-----------------------------------------------------
Fax | 606-564-4144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ANDREW W WOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-563-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------