Provider Demographics
NPI:1114418787
Name:DAIGLE MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:DAIGLE MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-393-3916
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-0062
Mailing Address - Country:US
Mailing Address - Phone:931-393-3916
Mailing Address - Fax:
Practice Address - Street 1:207 FAIRWAYS BLVD N
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4813
Practice Address - Country:US
Practice Address - Phone:931-393-3916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty