Provider Demographics
NPI:1043660137
Name:KIMBERLY RUTH MEDICAL SUPPLIES & EQUIP.
Entity Type:Organization
Organization Name:KIMBERLY RUTH MEDICAL SUPPLIES & EQUIP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-590-7993
Mailing Address - Street 1:516 DEVONIA ST
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2115
Mailing Address - Country:US
Mailing Address - Phone:865-590-7993
Mailing Address - Fax:
Practice Address - Street 1:516 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2115
Practice Address - Country:US
Practice Address - Phone:865-590-7993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1247332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies