1275539041 NPI number — AT HOME MEDICAL SUPPLY, INC.

Table of content: (NPI 1275539041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275539041 NPI number — AT HOME MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME MEDICAL SUPPLY, 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:
1275539041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1749 FLORIDA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38109-1957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-452-8770
Provider Business Mailing Address Fax Number:
901-452-9943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1749 FLORIDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38109-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-452-8770
Provider Business Practice Location Address Fax Number:
901-452-9943
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCNAIR
Authorized Official First Name:
MARSHA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
901-452-8770

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0000000824 , 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: 00883 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1454371 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13201 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2639857 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 145472 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003121711 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152026716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440681 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3121711 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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