Provider Demographics
NPI:1750377461
Name:HOME MEDICAL, INC.
Entity type:Organization
Organization Name:HOME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:801-627-0408
Mailing Address - Street 1:2562 MONROE BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2514
Mailing Address - Country:US
Mailing Address - Phone:801-627-0408
Mailing Address - Fax:
Practice Address - Street 1:2562 MONROE BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2514
Practice Address - Country:US
Practice Address - Phone:801-627-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50271901714332BX2000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========009Medicaid
4280730001Medicare ID - Type Unspecified