Provider Demographics
NPI:1194756361
Name:STULTZ HOME MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:STULTZ HOME MEDICAL SUPPLIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:STULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-473-7346
Mailing Address - Street 1:1615 ASHLAND RD
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-1207
Mailing Address - Country:US
Mailing Address - Phone:606-473-7346
Mailing Address - Fax:606-473-5667
Practice Address - Street 1:1615 ASHLAND RD
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1207
Practice Address - Country:US
Practice Address - Phone:606-831-1129
Practice Address - Fax:606-473-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90070459Medicaid
KY90070459Medicaid
KY0531210001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.