Provider Demographics
NPI:1497975569
Name:MICHELLE MARIE MONCIER
Entity Type:Organization
Organization Name:MICHELLE MARIE MONCIER
Other - Org Name:STATE OF FRANKLIN MOBILITY PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MONCIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-764-2713
Mailing Address - Street 1:1145 VOLUNTEER PARKWAY
Mailing Address - Street 2:STE 5
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-764-2713
Mailing Address - Fax:423-968-5481
Practice Address - Street 1:1145 VOLUNTEER PKWY
Practice Address - Street 2:SUTIE 5
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4652
Practice Address - Country:US
Practice Address - Phone:423-764-2713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000692332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0101OtherUNITED HEALTHCARE OF THE
TN1454205Medicaid
4170240001Medicare NSC