Basic Information
| Provider Information | |||||||||
| NPI: | 1598731762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME MEDICAL SUPPLY OF POPLAR BLUFF, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 SUNSET DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006825510 | ||||||||
| FaxNumber: | 5736866846 | ||||||||
| Practice Location | |||||||||
| Address1: | 639 GRAVOIS BLUFFS BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630267715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666157877 | ||||||||
| FaxNumber: | 6363430148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GARGAC | ||||||||
| AuthorizedOfficialFirstName: | MYLYNN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8006825510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 13165593 | MO | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.