Organization
STREET HOME MEDICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD SCOTT STREET (C.E.O.)
(478) 922-2889
Entity
Organization
Contact information
Practice address
1544 WATSON BLVD, WARNER ROBINS, GA 31093-3432
(478) 922-2889
(478) 922-9120
Mailing address
1544 WATSON BLVD, WARNER ROBINS, GA 31093-3432
(478) 922-2889
(478) 922-9120
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
62133
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000545982A
—
GA
Enumeration date
06/17/2006
Last updated
05/08/2012
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