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General NPI Number Information
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NPI Number | 1790780781
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Entity Type | Organization
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Legal Business Name | HOME MEDICAL SUPPLY OF POPLAR BLUFF, INC.
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1901 SUNSET DR
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2820
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Country | US
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Telephone | 800-682-5510
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Fax | 573-686-5510
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Provider Business Mailing Address
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Address Line | 1901 SUNSET DR
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2820
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Country | US
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Telephone | 800-682-5510
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Fax | 573-686-6846
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MYLYNN GARGAC
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Credential |
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Telephone | 800-682-5510
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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 |
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License Number State | MO
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