MEDICARE: HOMETOWN MEDICAL SUPPLIES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number
1	251E00000X	Home Health Agency
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	332B00000X	Durable Medical Equipment & Medical Supplies	10365

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

General Provider Information

NPI Number	:	1326037102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	PO BOX 1180
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653-1180
Country	:	US
Telephone Number	:	606-376-1551
Fax Number	:	606-376-4444

Provider Business Practice Location Address
First Line	:	25 MEDICAL LANE
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653
Country	:	US
Telephone Number	:	606-376-1551
Fax Number	:	606-376-4444

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERRY L PENNINGTON
Credential	:
Telephone Number	:	606-376-1551

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	04/15/2022

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