Provider Demographics
NPI:1225065147
Name:COMPREHENSIVE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-629-7793
Mailing Address - Street 1:PO BOX 91415
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-6415
Mailing Address - Country:US
Mailing Address - Phone:423-629-7793
Mailing Address - Fax:423-629-7199
Practice Address - Street 1:4120C RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-2436
Practice Address - Country:US
Practice Address - Phone:423-629-7793
Practice Address - Fax:423-629-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3037332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6090790001Medicare PIN
GA5731770001Medicare PIN