Provider Demographics
NPI:1275794943
Name:BATES, KELVIN L SR (EDS)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:L
Last Name:BATES
Suffix:SR
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12343 DALLAS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8762
Mailing Address - Country:US
Mailing Address - Phone:901-581-0447
Mailing Address - Fax:901-867-8626
Practice Address - Street 1:12343 DALLAS RIDGE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-8762
Practice Address - Country:US
Practice Address - Phone:901-581-0447
Practice Address - Fax:901-867-8626
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies