MEDICARE: HOGAN MEDICAL EQUIPMENT, 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	332BX2000X	Oxygen Equipment & Supplies (DME)	0206008439	VA

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
2	461711	OTHER	VA	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447251426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOGAN MEDICAL EQUIPMENT, INC

Provider Business Mailing Address
First Line	:	500 INTERSTATE PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-5429
Country	:	US
Telephone Number	:	334-777-1274
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 INTERSTATE PARK DR STE 534
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-5434
Country	:	US
Telephone Number	:	334-777-1274
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN HUMPHREY
Credential	:
Telephone Number	:	818-517-8743

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	11/02/2018

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