Provider Demographics
NPI:1497939482
Name:MTG FINANCIAL SERVICES AND ASSOC.
Entity Type:Organization
Organization Name:MTG FINANCIAL SERVICES AND ASSOC.
Other - Org Name:GOLDEN MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-854-7133
Mailing Address - Street 1:432 HIGHWAY 72 STE 1
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:432 HIGHWAY 72 STE 1
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2808
Practice Address - Country:US
Practice Address - Phone:901-854-7133
Practice Address - Fax:901-854-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455036Medicaid
MS04090625Medicaid
TN5241510001Medicare NSC