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General NPI Number Information
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NPI Number | 1629021225
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Entity Type | Organization
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Legal Business Name | SOUTHWEST VIRGINIA HOME MEDICAL, LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 134 CECIL D QUILLEN DR
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City | DUFFIELD
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State | VA
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Zip | 24244-9726
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Country | US
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Telephone | 276-431-0202
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Fax | 276-431-0203
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Provider Business Mailing Address
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Address Line | 134 CECIL D QUILLEN DR
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City | DUFFIELD
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State | VA
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Zip | 24244-9726
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Country | US
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Telephone | 276-431-0202
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Fax | 276-431-0203
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JIM R DAUGHERTY
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Credential |
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Telephone | 423-789-2010
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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 | 0206009338
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License Number State | VA
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