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General NPI Number Information
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NPI Number | 1649279845
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Entity Type | Organization
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Legal Business Name | ELLIS HOME HEALTH SUPPLIES, INC.
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 211 W MAIN ST
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City | ABINGDON
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State | VA
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Zip | 24210-2715
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Country | US
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Telephone | 276-628-2901
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Fax | 276-628-4526
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Provider Business Mailing Address
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Address Line | 211 W MAIN ST
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City | ABINGDON
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State | VA
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Zip | 24210-2715
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Country | US
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Telephone | 276-628-8181
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Fax | 276-628-6116
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. H. DOUGLAS ELLIS
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Credential |
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Telephone | 276-628-8181
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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 | 0206008402
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License Number State | VA
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