Organization
BRAXTEN HOME CARE MEDICAL EQUIPMENT, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROD PENCEK (OWNER)
(615) 220-5609
Entity
Organization
Contact information
Practice address
10579 CEDAR GROVE RD, SUITE 150, SMYRNA, TN 37167-8376
(615) 220-5609
(615) 220-5722
Mailing address
10579 CEDAR GROVE RD, SUITE 150, SMYRNA, TN 37167-8376
(615) 220-5609
(615) 220-5722
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0000002171
TN
332BX2000X
Oxygen Equipment & Supplies (DME)
0000002171
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4100563
—
TN
01
—
HEALTHSPRING
MEDICARE HMO
TN
Enumeration date
12/11/2006
Last updated
08/26/2011
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