Provider Demographics
NPI:1043298409
Name:WATERSTONE ACQUISITION, LLC
Entity Type:Organization
Organization Name:WATERSTONE ACQUISITION, LLC
Other - Org Name:PINNACLE HME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-463-9929
Mailing Address - Street 1:2341 W BEAVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4831
Mailing Address - Country:US
Mailing Address - Phone:800-355-7774
Mailing Address - Fax:
Practice Address - Street 1:2341 W BEAVER CREEK DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4831
Practice Address - Country:US
Practice Address - Phone:800-355-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHMER-23311-HQAAOtherSTATE OF OH - DME LICENSE
TN1185OtherSTATE OF TN - DME LICENSE
TN1454915Medicaid
AZC001080OtherSTATE OF AZ - DME LICENSE
LADME 000556OtherSTATE OF LA - DME LICENSE
IN69001212AOtherSTATE OF IN - DME LICENSE
TN5141580001Medicare NSC