Organization
TARGET MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS R BROCKWAY SR. (PRESIDENT)
(901) 323-1304
Entity
Organization
Contact information
Practice address
2158 HEYDE AV, STE 7, MEMPHIS, TN 38114-4840
(901) 323-1304
(901) 323-1275
Mailing address
2158 HEYDE AV, STE 7, MEMPHIS, TN 38114-4840
(901) 323-1304
(901) 323-1275
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0000001104
TN
332B00000X
Durable Medical Equipment & Medical Supplies
04203 / 11.1
MS
332B00000X
Durable Medical Equipment & Medical Supplies
MG01258
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452059
—
TN
01
—
20077
TLC HME/DME PROVIDER
TN
01
—
3008232
TCS/BCBS HME/DME PROVIDR
TN
01
—
MG01258
BOARD OF PHARMACY - SUPPLIER OF MEDICAL EQUIPMENT, & MEDICAL GAS PERMIT
AR
Enumeration date
03/07/2006
Last updated
03/07/2012
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