Provider Demographics
NPI:1699773143
Name:YOUR HOME TOWN MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:YOUR HOME TOWN MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:620-670-6080
Mailing Address - Street 1:1615 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-3049
Mailing Address - Country:US
Mailing Address - Phone:620-670-6080
Mailing Address - Fax:620-223-2374
Practice Address - Street 1:1615 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-3049
Practice Address - Country:US
Practice Address - Phone:620-670-6080
Practice Address - Fax:620-223-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2024-05-28
Deactivation Date:2012-02-29
Deactivation Code:
Reactivation Date:2016-03-22
Provider Licenses
StateLicense IDTaxonomies
KS16103515332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003910720001Medicaid
KS118092OtherDME
KS30003910720002Medicaid
KS4578940001Medicare NSC
KS100445510AMedicaid