Provider Demographics
NPI:1487666442
Name:MEDI-SERV. INC.
Entity Type:Organization
Organization Name:MEDI-SERV. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:T
Authorized Official - Last Name:MANGUBAT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:931-722-9047
Mailing Address - Street 1:POB 871
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-0871
Mailing Address - Country:US
Mailing Address - Phone:931-722-9047
Mailing Address - Fax:931-722-9053
Practice Address - Street 1:209 SOUTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-0871
Practice Address - Country:US
Practice Address - Phone:931-722-9047
Practice Address - Fax:931-722-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001745332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4058299OtherBCBS PROVIDER NUMBER
TN4058299OtherBC/BS
TN4058299OtherBCBS PROVIDER NUMBER
TN4058299OtherBC/BS