Provider Demographics
NPI:1194000224
Name:ACCESS DME FO
Entity Type:Organization
Organization Name:ACCESS DME FO
Other - Org Name:ACCESS DME FO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-3568
Mailing Address - Street 1:4062 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3110
Mailing Address - Country:US
Mailing Address - Phone:423-877-3568
Mailing Address - Fax:423-877-9332
Practice Address - Street 1:89 CRYE LEIKE DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4055
Practice Address - Country:US
Practice Address - Phone:706-858-6771
Practice Address - Fax:706-858-6772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS DME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000512332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4706020001Medicare NSC