Provider Demographics
NPI:1093851362
Name:AFFINITY REHAB AND MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:AFFINITY REHAB AND MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-964-0880
Mailing Address - Street 1:4937 HIGHWAY 43 N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUMMERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38483-7052
Mailing Address - Country:US
Mailing Address - Phone:931-964-0880
Mailing Address - Fax:931-964-0886
Practice Address - Street 1:4937 HIGHWAY 43 N
Practice Address - Street 2:SUITE 101
Practice Address - City:SUMMERTOWN
Practice Address - State:TN
Practice Address - Zip Code:38483-7052
Practice Address - Country:US
Practice Address - Phone:931-964-0880
Practice Address - Fax:931-964-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455157Medicaid
TN1053538OtherAMERIGROUP COMMUNITY CARE
TN4153548OtherBLUECROSS BLUESHIELD
TN4153548OtherBLUECROSS BLUESHIELD