Organization
HOMESIDE HEALTHCARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW W WOOD (PRESIDENT)
(606) 563-9400
Entity
Organization
Contact information
Practice address
1315 US 68 SOUTHGATE PLAZA, MAYSVILLE, KY 41056-9132
(606) 563-9400
(606) 564-4144
Mailing address
1315 US 68, MAYSVILLE, KY 41056-9132
(606) 563-9400
(606) 564-4144
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000229563
ANTHEM
—
01
—
2324783
MEDICAID
OH
05
—
90003476
—
KY
Enumeration date
11/14/2006
Last updated
04/20/2010
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