Provider Demographics
NPI:1275539041
Name:AT HOME MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:AT HOME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-452-8770
Mailing Address - Street 1:1749 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-1957
Mailing Address - Country:US
Mailing Address - Phone:901-452-8770
Mailing Address - Fax:901-452-9943
Practice Address - Street 1:1749 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-1957
Practice Address - Country:US
Practice Address - Phone:901-452-8770
Practice Address - Fax:901-452-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000824332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00883Medicaid
TN1454371Medicaid
TN13201Medicaid
TN2639857OtherAETNA
TN145472Medicaid
TN003121711Medicaid
AR152026716Medicaid
MS00440681Medicaid
TN3121711OtherBLUE CROSS BLUE SHIELD
TN00883Medicaid