Organization
DOC SUPPLY OF WEST TENNESSEE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT THOMAS BALDRIDGE ATP (OWNER)
(800) 306-5160
Entity
Organization
Contact information
Practice address
2192 EXPRESS DRIVE, SUITE C, JACKSON, TN 38305
(800) 306-5160
(800) 481-1206
Mailing address
2192 EXPRESS DRIVE, SUITE C, JACKSON, TN 38305
(800) 306-5160
(800) 481-1206
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1014
TN
332BC3200X
Customized Equipment (DME)
1014
TN
Other
Enumeration date
02/03/2010
Last updated
10/08/2021
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