Provider Demographics
NPI:1083680938
Name:HOME MEDICAL SUPPLIES & EQUIPMENT, INC.
Entity type:Organization
Organization Name:HOME MEDICAL SUPPLIES & EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-729-5851
Mailing Address - Street 1:415 ALTMAN ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3656
Mailing Address - Country:US
Mailing Address - Phone:843-761-3248
Mailing Address - Fax:843-761-2764
Practice Address - Street 1:415 ALTMAN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3656
Practice Address - Country:US
Practice Address - Phone:843-761-3248
Practice Address - Fax:843-761-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008147819S332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1415Medicaid
SC=========OtherBLUE CROSS BLUE SHIELD
SC=========OtherBLUE CROSS BLUE SHIELD