MEDICARE: IN-HOME MEDICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332B00000X	Durable Medical Equipment & Medical Supplies	0622765	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1223940001	OTHER	VA	MEDICARE SUPPLIER DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	294463	OTHER	VA	AMERIGROUP PROVIDER NUMBE

General Provider Information

NPI Number	:	1124133558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN-HOME MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	6911 RICHMOND HWY STE 320
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1846
Country	:	US
Telephone Number	:	703-768-4440
Fax Number	:	703-768-0923

Provider Business Practice Location Address
First Line	:	6911 RICHMOND HWY STE 320
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1846
Country	:	US
Telephone Number	:	703-768-4440
Fax Number	:	703-768-0923

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLORIA STALLWORTH
Credential	:
Telephone Number	:	703-768-4440

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	02/14/2025

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Directions to “IN-HOME MEDICAL SUPPLY, INC. ” Practice Location

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