Provider Demographics
NPI:1235101189
Name:HART COUNTY RESPIRATORY CARE INC
Entity type:Organization
Organization Name:HART COUNTY RESPIRATORY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-771-6501
Mailing Address - Street 1:6414 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3576
Mailing Address - Country:US
Mailing Address - Phone:402-281-4404
Mailing Address - Fax:402-281-4470
Practice Address - Street 1:1483 S DIXIE ST STE A
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1457
Practice Address - Country:US
Practice Address - Phone:270-786-2997
Practice Address - Fax:270-786-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-05
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY123683332B00000X, 332BX2000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000066631OtherANTHEM PROVIDER NUMBER
KY1088062Medicaid
KY7100802180Medicaid
KY90110503Medicaid