Supermommy'S Superstore, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SUPERMOMMY'S SUPERSTORE, LLC

Practice address

2411 Ring Rd
Suite 105
Elizabethtown, KY 42701-5929

Phone

(270) 769-6693

Fax

(270) 769-0911

NPI assigned

Jun 3, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Regina Rae Hagan

Title

Owner

Phone

(270) 769-6693

Specialties & licenses 1

Addresses

Other names 1

• Supermommy's Superstore Doing business as

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243987200000",
    "number": "1639305709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268",
            "city": "RINEYVILLE",
            "state": "KY",
            "postal_code": "401620268",
            "telephone_number": "270-769-6693",
            "fax_number": "270-769-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 RING RD",
            "address_2": "SUITE 105",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427015929",
            "telephone_number": "270-769-6693",
            "fax_number": "270-769-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERMOMMY'S SUPERSTORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-03",
        "last_updated": "2009-06-03",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-769-6693",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supermommy's Superstore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Suresh Kodali
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• Durable Medical Equipment & Medical Supplies in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Durable Medical Equipment & Medical Supplies in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.