Provider Demographics
NPI:1588727937
Name:AT HOME MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:AT HOME MEDICAL SUPPLY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, RETAIL DME
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-608-0305
Mailing Address - Street 1:651 N BUSINESS IH 35
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7874
Mailing Address - Country:US
Mailing Address - Phone:830-698-0305
Mailing Address - Fax:830-620-0796
Practice Address - Street 1:651 N BUSINESS IH 35
Practice Address - Street 2:SUITE 330
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7874
Practice Address - Country:US
Practice Address - Phone:830-698-0305
Practice Address - Fax:830-620-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412914332B00000X, 332BX2000X
TXTX 0013805332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5833050001Medicare NSC