Provider Demographics
NPI:1124133558
Name:IN-HOME MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:IN-HOME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-768-4440
Mailing Address - Street 1:6911 RICHMOND HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1846
Mailing Address - Country:US
Mailing Address - Phone:703-768-4440
Mailing Address - Fax:703-768-0923
Practice Address - Street 1:6911 RICHMOND HWY STE 320
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1846
Practice Address - Country:US
Practice Address - Phone:703-768-4440
Practice Address - Fax:703-768-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VA0622765332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009114700Medicaid
VA1223940001OtherMEDICARE SUPPLIER DME
VA294463OtherAMERIGROUP PROVIDER NUMBE
VA1223940001OtherMEDICARE SUPPLIER DME
VA294463OtherAMERIGROUP PROVIDER NUMBE
VA1223940001Medicare PIN