1871542118 NPI number — DIRECT MEDICAL SUPPLIES, LLC

Table of content: (NPI 1871542118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871542118 NPI number — DIRECT MEDICAL SUPPLIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIRECT MEDICAL SUPPLIES, LLC
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:
1871542118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7285 WINCHESTER RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38125-2164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-737-5069
Provider Business Mailing Address Fax Number:
901-737-5078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7285 WINCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38125-2164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-737-5069
Provider Business Practice Location Address Fax Number:
901-737-5078
Provider Enumeration Date:
05/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
901-737-5069

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  617 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333300000X , with the licence number: 617 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 617 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4067605 . This is a "BCBS TN PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1452535 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467715 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4067605 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: H445036 . This is a "TN COMMISSION ON AGING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00440826 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24698 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25225 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49873 . This is a "BCBS AR PROVIDER NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 142674716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144931 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5261409009 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 392849 . This is a "BCBS KS PROVIDER NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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