Provider Demographics
NPI:1053422816
Name:PIONEER HOME MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:PIONEER HOME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:TABASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-285-5227
Mailing Address - Street 1:2611 PLAZA PKWY STE 301B
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3870
Mailing Address - Country:US
Mailing Address - Phone:940-285-5227
Mailing Address - Fax:844-527-4901
Practice Address - Street 1:2611 PLAZA PKWY STE 301B
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3870
Practice Address - Country:US
Practice Address - Phone:940-285-5227
Practice Address - Fax:866-546-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183653801Medicaid
TX5793910001Medicare NSC