Organization
AT HOME MEDICAL SUPPLY OF TN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA MCNAIR (CFO)
(901) 452-2395
Entity
Organization
Contact information
Practice address
86 E NORTHSTAR DR, SUITE E, JACKSON, TN 38305
(731) 512-1895
(731) 512-1896
Mailing address
86 E NORTHSTAR DR, SUITE E, JACKSON, TN 38305
(731) 512-1895
(731) 512-1896
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0000000824
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452412
—
TN
01
—
4080747
BLUE CROSS & BLUE SHIELD
TN
05
—
4080747
—
TN
Enumeration date
06/28/2005
Last updated
11/09/2007
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