MEDICARE: HOME MEDICAL SUPPLY OF POPLAR BLUFF, 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	13165593	MO

General Provider Information

NPI Number	:	1598731762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME MEDICAL SUPPLY OF POPLAR BLUFF, INC.

Provider Business Mailing Address
First Line	:	1901 SUNSET DR
Second Line	:	SUITE A
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2820
Country	:	US
Telephone Number	:	800-682-5510
Fax Number	:	573-686-6846

Provider Business Practice Location Address
First Line	:	639 GRAVOIS BLUFFS BLVD
Second Line	:	SUITE D
City	:	FENTON
State	:	MO
Zip	:	63026-7715
Country	:	US
Telephone Number	:	866-615-7877
Fax Number	:	636-343-0148

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MYLYNN GARGAC
Credential	:
Telephone Number	:	800-682-5510

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/22/2020

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