Basic Information
| Provider Information | |||||||||
| NPI: | 1437493574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALITY HOME MEDICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 ROGERS COMMERCE BLVD | ||||||||
| Address2: | |||||||||
| City: | BOILING SPRINGS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293166144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645999945 | ||||||||
| FaxNumber: | 8645997713 | ||||||||
| Practice Location | |||||||||
| Address1: | 362 N PINE ST | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645999945 | ||||||||
| FaxNumber: | 8645997713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | FULLER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8645999945 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 042543382 | SC | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1178540004 | 01 | SC | MEDICARE PTAN | OTHER | DE1135 | 05 | SC | MEDICAID |