Provider Demographics
NPI:1306961446
Name:HOMETOWN MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:HOMETOWN MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-265-4100
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-0329
Mailing Address - Country:US
Mailing Address - Phone:870-265-4100
Mailing Address - Fax:870-265-6047
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1941
Practice Address - Country:US
Practice Address - Phone:870-265-4100
Practice Address - Fax:870-265-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49507OtherBCBS
AR135374716Medicaid