=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881769297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN TIER HOME MEDICAL SUPPLIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67 N MAIN ST
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14895-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-593-3050
-----------------------------------------------------
Fax | 585-593-3051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67 N MAIN ST
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14895-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-593-3050
-----------------------------------------------------
Fax | 585-593-3051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MRS. KIMBERLY KAY NOLLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-593-3050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------