Provider Demographics
NPI:1043379969
Name:MODERN MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:MODERN MEDICAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WALTON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:731-855-0181
Mailing Address - Street 1:P O BOX 161
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382
Mailing Address - Country:US
Mailing Address - Phone:731-855-0181
Mailing Address - Fax:731-855-1312
Practice Address - Street 1:206 W EATON ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382
Practice Address - Country:US
Practice Address - Phone:731-855-0181
Practice Address - Fax:731-855-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3553468Medicaid
TN3553468Medicaid