Organization
PARAGON MEDICAL ENTEPRISES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM JEROLD STOUT (PRESIDENT)
(423) 336-1651
Entity
Organization
Contact information
Practice address
390 BELLFOUNTE RD NE, CLEVELAND, TN 37312-6602
(423) 336-1651
(423) 336-1597
Mailing address
PO BOX 1301, CLEVELAND, TN 37364-1301
(423) 336-1651
(423) 336-1597
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009603700
—
AL
Enumeration date
11/06/2006
Last updated
05/21/2008
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