Provider Demographics
NPI:1417933631
Name:EDDIE TEST MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:EDDIE TEST MEDICAL EQUIPMENT INC
Other - Org Name:EDDIE TEST'S HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:TEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-965-8378
Mailing Address - Street 1:55 GENERAL CLEBURNE STREET
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736
Mailing Address - Country:US
Mailing Address - Phone:706-965-8378
Mailing Address - Fax:706-965-6672
Practice Address - Street 1:55 GENERAL CLEBURNE STREET
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736
Practice Address - Country:US
Practice Address - Phone:706-965-8378
Practice Address - Fax:706-965-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20006035684332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00358091BMedicaid
GA52173688OtherBLUE CROSS BLUE SHIELD GA
TN91754OtherBLUE CROSS BLUE SHIELD TN
GA00358091BMedicaid