MEDICARE: HOSPITAL EQUIPMENT AND HOME NUTRITIONAL THERAPY, 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	05001347	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56588	OTHER	AL	BLUE CROSS BLUE SHIELD
2	1404366	OTHER	AL	UMWA

General Provider Information

NPI Number	:	1184616906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL EQUIPMENT AND HOME NUTRITIONAL THERAPY, INC

Provider Business Mailing Address
First Line	:	119 HIGHLANDER DR
Second Line	:
City	:	HUEYTOWN
State	:	AL
Zip	:	35023-2720
Country	:	US
Telephone Number	:	205-491-6836
Fax Number	:	205-424-6786

Provider Business Practice Location Address
First Line	:	727 MEMORIAL DR
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-6029
Country	:	US
Telephone Number	:	205-428-5113
Fax Number	:	205-424-6786

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES RAY WALL
Credential	:	RPH
Telephone Number	:	205-428-5113

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/22/2020

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