Provider Demographics
NPI:1467145987
Name:PLUSPARK MEDICAL SUPPLY
Entity Type:Organization
Organization Name:PLUSPARK MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EFE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-403-2916
Mailing Address - Street 1:325 PLUS PARK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-1037
Mailing Address - Country:US
Mailing Address - Phone:615-678-4065
Mailing Address - Fax:
Practice Address - Street 1:325 PLUS PARK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1037
Practice Address - Country:US
Practice Address - Phone:615-678-4065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies