Provider Demographics
NPI:1083680748
Name:GORDON BEATS EARNHART AGAIN LLC
Entity Type:Organization
Organization Name:GORDON BEATS EARNHART AGAIN LLC
Other - Org Name:O2 FOR YOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-796-7965
Mailing Address - Street 1:37 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462
Mailing Address - Country:US
Mailing Address - Phone:931-796-7965
Mailing Address - Fax:931-796-1176
Practice Address - Street 1:37 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462
Practice Address - Country:US
Practice Address - Phone:931-796-7965
Practice Address - Fax:931-796-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
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
3021176OtherBLUE CROSS TN
TN1452395Medicaid
1253880001Medicare ID - Type Unspecified