MEDICARE: YOUR HEALTH SUPPLIES 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	20167370	AZ

General Provider Information

NPI Number	:	1790987444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR HEALTH SUPPLIES INC

Provider Business Mailing Address
First Line	:	4920 W THUNDERBIRD RD
Second Line	:	STE 125
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4905
Country	:	US
Telephone Number	:	602-439-2771
Fax Number	:	602-439-2789

Provider Business Practice Location Address
First Line	:	4920 W THUNDERBIRD RD
Second Line	:	STE 125
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4905
Country	:	US
Telephone Number	:	602-439-2771
Fax Number	:	602-439-2789

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SERGIY KHOMYAK
Credential	:
Telephone Number	:	605-439-2771

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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