Provider Demographics
NPI:1053521849
Name:H & G HOME MEDICAL LLC
Entity type:Organization
Organization Name:H & G HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-333-4848
Mailing Address - Street 1:112 NE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-1650
Mailing Address - Country:US
Mailing Address - Phone:918-333-4848
Mailing Address - Fax:918-333-8948
Practice Address - Street 1:112 NE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-1650
Practice Address - Country:US
Practice Address - Phone:918-333-4848
Practice Address - Fax:918-333-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9-42963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100812150BMedicaid
OK1206420001Medicare ID - Type Unspecified