MEDICARE: ADVANCED HOME MEDICAL 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)

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	000000301041	OTHER	KY	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1831287150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HOME MEDICAL INC

Provider Business Mailing Address
First Line	:	2212 FORT CAMPBELL BLVD
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-4665
Country	:	US
Telephone Number	:	270-886-2544
Fax Number	:	270-881-4799

Provider Business Practice Location Address
First Line	:	2212 FORT CAMPBELL BLVD
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-4665
Country	:	US
Telephone Number	:	270-886-2544
Fax Number	:	270-881-4799

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRANK FIELD
Credential	:
Telephone Number	:	270-886-2544

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/07/2021

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Directions to “ADVANCED HOME MEDICAL INC ” Practice Location

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