Provider Demographics
NPI:1356510879
Name:CAVALIER MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:CAVALIER MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:731-696-4000
Mailing Address - Street 1:8 N CAVALIER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-6468
Mailing Address - Country:US
Mailing Address - Phone:731-696-4000
Mailing Address - Fax:731-696-4001
Practice Address - Street 1:8 N CAVALIER DR
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-6468
Practice Address - Country:US
Practice Address - Phone:731-696-4000
Practice Address - Fax:731-696-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies