1649276270 NPI number — AT HOME MEDICAL SUPPLY OF TN LLC

Table of content: (NPI 1649276270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649276270 NPI number — AT HOME MEDICAL SUPPLY OF TN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME MEDICAL SUPPLY OF TN 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:
1649276270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
86 E NORTHSTAR DR
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-512-1895
Provider Business Mailing Address Fax Number:
731-512-1896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 E NORTHSTAR DR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-512-1895
Provider Business Practice Location Address Fax Number:
731-512-1896
Provider Enumeration Date:
06/28/2005

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:
901-452-2395

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: 1452412 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4080747 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4080747 . 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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