NPIMap

Organization Active NPI

Mrs Homecare, Inc.

Doing business as Mrs of Moultrie

  • Oxygen Equipment & Supplies (DME)
  • Moultrie, GA
National Provider Identifier
1043213358
Registry record updated May 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
Legal business name
MRS HOMECARE, INC.
Doing business as
Mrs of Moultrie
Practice address
2467A S Main St
Moultrie, GA 31768-6531
Phone
(229) 890-6949
Fax
(229) 890-7386
NPI assigned
May 31, 2005
Last updated
May 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. E. Thomas Riddle
Title
President
Phone
(229) 439-2403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X Primary

Addresses

Primary practice location

2467A S Main St
Moultrie, GA 31768-6531

Mailing address

PO Box 568
Albany, GA 31702-0568
Phone (229) 439-2403

Other identifiers 1

IdentifierTypeStateIssuer
000238697KMedicaidGA

Other names 1

  • MRS OF MOULTRIE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930067356 GA DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply CompanyDME Supplier - Orthotic PersonnelDME Supplier - Oxygen & Equipment 7810015575 Practice locations: Moultrie, GA

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mrs of Lagrange15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

2467A S Main St
Moultrie, GA 31768
Phone (229) 890-6949

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336435200000",
    "number": "1043213358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317020568",
            "telephone_number": "229-439-2403",
            "fax_number": "229-883-8426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2467A S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686531",
            "telephone_number": "229-890-6949",
            "fax_number": "229-890-7386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MRS HOMECARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2012-05-08",
        "status": "A",
        "authorized_official_last_name": "RIDDLE",
        "authorized_official_first_name": "E.",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-439-2403",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000238697K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MRS OF MOULTRIE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moultrie, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.