Provider Demographics
NPI:1124176359
Name:FAMILY HOME MEDICAL INC
Entity type:Organization
Organization Name:FAMILY HOME MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-925-7009
Mailing Address - Street 1:PO BOX 2597
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-0009
Mailing Address - Country:US
Mailing Address - Phone:916-925-7009
Mailing Address - Fax:888-577-6924
Practice Address - Street 1:5525 DEWEY DRIVE
Practice Address - Street 2:SUITE 106A
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3130
Practice Address - Country:US
Practice Address - Phone:916-925-7009
Practice Address - Fax:888-577-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23663332BX2000X
CA59510332BX2000X
CA56024332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02702FMedicaid
CA56024OtherCA DHS/FDB
CADME02702FMedicaid