Provider Demographics
NPI:1144207432
Name:EMBRY WELDING SUPPLY INC
Entity type:Organization
Organization Name:EMBRY WELDING SUPPLY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:270-879-9287
Mailing Address - Street 1:10 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:CANEYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42721-9176
Mailing Address - Country:US
Mailing Address - Phone:270-879-9287
Mailing Address - Fax:270-879-3405
Practice Address - Street 1:10 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:CANEYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42721-9176
Practice Address - Country:US
Practice Address - Phone:270-879-9287
Practice Address - Fax:270-879-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY074211332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90010430Medicaid
KY0167120001Medicare NSC