Provider Demographics
NPI:1245415785
Name:HUEDO DIAGNOSTICS DME, LLC
Entity Type:Organization
Organization Name:HUEDO DIAGNOSTICS DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYFORD
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RRT, RPSGT
Authorized Official - Phone:423-283-1003
Mailing Address - Street 1:100 W SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1716
Mailing Address - Country:US
Mailing Address - Phone:423-283-1003
Mailing Address - Fax:423-283-1007
Practice Address - Street 1:100 W SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1716
Practice Address - Country:US
Practice Address - Phone:423-283-1003
Practice Address - Fax:423-283-1007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUEDO DIAGNOSTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0556056332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies