Provider Demographics
NPI:1538158662
Name:GREENVILLE HOME TOWN MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:GREENVILLE HOME TOWN MEDICAL EQUIPMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-455-4788
Mailing Address - Street 1:2701 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4113
Mailing Address - Country:US
Mailing Address - Phone:903-455-4788
Mailing Address - Fax:903-455-4695
Practice Address - Street 1:2701 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4113
Practice Address - Country:US
Practice Address - Phone:903-455-4788
Practice Address - Fax:903-455-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0010866332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20556OtherPHARMACY
TX530745OtherBLUE CROSS BLUE SHIELD TX
TX3861690001Medicare ID - Type Unspecified