Organization
NUTRITIONAL SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY LEEMAN (EXECUTIVE DIRECTOR)
(865) 690-9900
Entity
Organization
Contact information
Practice address
9000 EXECUTIVE PARK DRIVE, SUITE A 301, KNOXVILLE, TN 37923-4656
(865) 690-9900
(865) 531-7016
Mailing address
PO BOX 32249, KNOXVILLE, TN 37930-2249
(865) 690-9900
(865) 531-7016
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00571986A
—
GA
05
—
009000730
—
AL
05
—
01305375
—
NY
05
—
073622502
—
TX
05
—
100002960A
—
KS
05
—
100010580A
—
IN
01
—
10MF49
ALLIANCE BCBS
—
05
—
112948716
—
AR
05
—
1354317
—
LA
05
—
209086400
—
FL
05
—
30762373
—
NH
05
—
3545979
—
TN
05
—
40111
—
MS
05
—
622293603
—
MO
05
—
7611272
—
MN
05
—
80966900
—
WI
05
—
90262056
—
KY
05
—
9143513
—
VA
05
—
DM0001
—
SC
Enumeration date
06/26/2006
Last updated
01/28/2020
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