Professional Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

182153 Issued in KY

Legal business name

PROFESSIONAL MEDICAL SUPPLY LLC

Practice address

342 Bogle St
Ste 1
Somerset, KY 42503-2851

Phone

(606) 451-0216

Fax

(606) 451-1959

NPI assigned

Jul 7, 2005

Organization subpart

No

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

Authorized official

Name

Freddy C Mullins, RRT

Title

MGR Owner

Phone

(606) 451-0216

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1932106663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 BOGLE ST",
            "address_2": "STE 1",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425032851",
            "telephone_number": "606-451-0216",
            "fax_number": "606-451-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 BOGLE ST",
            "address_2": "STE 1",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425032851",
            "telephone_number": "606-451-0216",
            "fax_number": "606-451-1959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-04-10",
        "status": "A",
        "authorized_official_last_name": "MULLINS",
        "authorized_official_first_name": "FREDDY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MGR OWNER",
        "authorized_official_telephone_number": "606-451-0216",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "182153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90013822",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Somerset, KY
• Providers in Somerset, 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 Apr 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.