Organization
KENTUCKY MEDICAL SUPPLY, INC.
Active
Parent organization
AEROCARE HOLDINGS, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
AEROCARE HOLDINGS, INC.
Authorized official
MR. STEPHEN P GRIGGS (CEO/ PRESIDENT)
(407) 206-0040
Entity
Organization
Contact information
Practice address
102 CASTLE RIDGE DR, EDMONTON, KY 42129
(270) 432-0957
(270) 432-0957
Mailing address
3325 BARTLETT BLVD, ORLANDO, FL 32811-6428
(407) 206-0040
(407) 206-0010
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
KY
332B00000X
Durable Medical Equipment & Medical Supplies
177855
KY
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
175293
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000070314
BC PROVIDER ID NO.
KY
01
—
45907789
EPSDT PROVIDER ID NO.
KY
01
—
7542
CHA PROVIDER ID NO.
KY
05
—
90100058
—
KY
Enumeration date
06/16/2005
Last updated
06/15/2020
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