Provider Demographics
NPI:1548571268
Name:MEDICAL NATIONAL MEDICAL SUPPLY COMPANY, LLC
Entity Type:Organization
Organization Name:MEDICAL NATIONAL MEDICAL SUPPLY COMPANY, LLC
Other - Org Name:TMN MEDICAL SUPPLY COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-822-8951
Mailing Address - Street 1:2716 WINDSOR CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6040
Mailing Address - Country:US
Mailing Address - Phone:404-822-8951
Mailing Address - Fax:678-797-0660
Practice Address - Street 1:2716 WINDSOR CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6040
Practice Address - Country:US
Practice Address - Phone:404-822-8951
Practice Address - Fax:678-797-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2010#135340332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies