1740454636 NPI number — DYERSBURG UNIFORM SHOPPE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740454636 NPI number — DYERSBURG UNIFORM SHOPPE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYERSBURG UNIFORM SHOPPE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740454636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2455 LAKE RD
Provider Second Line Business Mailing Address:
DYERSBURG UNIFORM SHOPPE
Provider Business Mailing Address City Name:
DYERSBURG
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-285-1778
Provider Business Mailing Address Fax Number:
731-285-1766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2455 LAKE RD
Provider Second Line Business Practice Location Address:
DYERSBURG UNIFORM SHOPPE
Provider Business Practice Location Address City Name:
DYERSBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-285-1778
Provider Business Practice Location Address Fax Number:
731-285-1766
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOSLIN
Authorized Official First Name:
TOMMYE
Authorized Official Middle Name:
CAROLYN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
731-285-1778

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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