Provider Demographics
NPI:1104958099
Name:HOMETOWN MEDICAL SUPPLIES
Entity type:Organization
Organization Name:HOMETOWN MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-543-3860
Mailing Address - Street 1:515 LANSING STREET
Mailing Address - Street 2:SUITE B 1
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813
Mailing Address - Country:US
Mailing Address - Phone:517-541-1511
Mailing Address - Fax:517-541-1519
Practice Address - Street 1:515 LANSING ST
Practice Address - Street 2:SUITE B 1
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1100
Practice Address - Country:US
Practice Address - Phone:517-541-1511
Practice Address - Fax:517-541-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies