Provider Demographics
NPI:1487988812
Name:1ST AMERICA HOME MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:1ST AMERICA HOME MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-242-3060
Mailing Address - Street 1:212 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1858
Mailing Address - Country:US
Mailing Address - Phone:229-242-1000
Mailing Address - Fax:229-242-2120
Practice Address - Street 1:2717 WINDEMERE DR
Practice Address - Street 2:STE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1686
Practice Address - Country:US
Practice Address - Phone:229-242-1000
Practice Address - Fax:229-242-2120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST AMERICA HOME MEDICAL EQUIPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00339248CMedicaid
GA00339248BMedicaid
GA00339248CMedicaid