Provider Demographics
NPI:1447251426
Name:HOGAN MEDICAL EQUIPMENT, INC
Entity type:Organization
Organization Name:HOGAN MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-517-8743
Mailing Address - Street 1:500 INTERSTATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-5429
Mailing Address - Country:US
Mailing Address - Phone:334-777-1274
Mailing Address - Fax:
Practice Address - Street 1:500 INTERSTATE PARK DR STE 534
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-5434
Practice Address - Country:US
Practice Address - Phone:334-777-1274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206008439332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009101039Medicaid
VA461711OtherANTHEM BC/BS
WV6202040000Medicaid
4316920001Medicare NSC