NPIMap

Organization Active NPI

P & R Home IV Service, Inc.

  • Oxygen Equipment & Supplies (DME)
  • Van Wert, OH
National Provider Identifier
1962817874
Registry record updated Jun 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
License
HMER.22207 Issued in OH
Legal business name
P & R HOME IV SERVICE, INC.
Doing business as
P & R MEDICAL CONNECTION
Practice address
1113 S. Shannon Street
Van Wert, OH 45891-8619
Phone
(419) 238-9828
Fax
(419) 238-6289
NPI assigned
Jun 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2014

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

Authorized official

Name
Mrs. Robin Sue Farris
Title
Secretary/Treasurer
Phone
(800) 587-7670

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X HMER.22207 OH Primary

Addresses

Primary practice location

1113 S. Shannon Street
Van Wert, OH 45891-8619

Mailing address

16937 Defiance TRL
Van Wert, OH 45891-8619
Phone (800) 587-7670

Other identifiers 3

IdentifierTypeStateIssuer
1124131925OtherOHMEDICARE NPI
0631301MedicaidOH
201007250AMedicaidIN

Other names 1

  • P & R MEDICAL CONNECTION Doing business as

National Provider Directory

National Provider Directory
Tax ID family
P R Home IV Service Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1962817874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16937 DEFIANCE TRL",
            "city": "VAN WERT",
            "state": "OH",
            "postal_code": "458918619",
            "telephone_number": "800-587-7670",
            "fax_number": "419-587-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 S. SHANNON STREET",
            "city": "VAN WERT",
            "state": "OH",
            "postal_code": "458918619",
            "telephone_number": "419-238-9828",
            "fax_number": "419-238-6289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P & R HOME IV SERVICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "FARRIS",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "800-587-7670",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "OH",
            "license": "HMER.22207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI",
            "identifier": "1124131925",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0631301",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201007250A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "P & R MEDICAL CONNECTION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Van Wert, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; 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.