MEDICARE: HOMEBOUND MEDICAL SUPPLY CO

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)	00062	NC
2	335E00000X	Prosthetic/Orthotic Supplier	00062	NC
3	332B00000X	Durable Medical Equipment & Medical Supplies	00062	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0495W	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700879194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMEBOUND MEDICAL SUPPLY CO

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:	615 E SOUTHERLAND ST
City	:	WALLACE
State	:	NC
Zip	:	28466-0070
Country	:	US
Telephone Number	:	910-285-4410
Fax Number	:	910-285-7505

Provider Business Practice Location Address
First Line	:	615 E SOUTHERLAND ST
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-0070
Country	:	US
Telephone Number	:	910-285-4410
Fax Number	:	910-285-7505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HORACE VERNON PIGFORD JR.
Credential	:
Telephone Number	:	910-285-4410

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/16/2012

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Directions to “HOMEBOUND MEDICAL SUPPLY CO ” Practice Location

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