Organization
SOUTHERN MEDICAL
Active
Other names
ED MEDICAL INC
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER BLAKELY (CEO/OWNER)
(615) 822-8888
Entity
Organization
Contact information
Practice address
106 FREE HILL RD, HENDERSONVILLE, TN 37075-3495
(615) 822-8888
(615) 822-8280
Mailing address
106 FREE HILL ROAD, HENDERSONVILLE, TN 37075-3495
(615) 822-8888
(615) 822-8280
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000444
STATE LICENSE
TN
Enumeration date
11/04/2008
Last updated
04/05/2023
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