1154400323 NPI number — PARAGON MEDICAL ENTEPRISES INC

Table of content: (NPI 1154400323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154400323 NPI number — PARAGON MEDICAL ENTEPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGON MEDICAL ENTEPRISES INC
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:
1154400323
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:
PO BOX 1301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37364-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-336-1651
Provider Business Mailing Address Fax Number:
423-336-1597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 BELLFOUNTE RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37312-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-336-1651
Provider Business Practice Location Address Fax Number:
423-336-1597
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOUT
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JEROLD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-336-1651

Provider Taxonomy Codes

  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009603700 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com