Provider Demographics
NPI:1639262330
Name:PROMED EQUIPMENT COMPANY, LLC
Entity Type:Organization
Organization Name:PROMED EQUIPMENT COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-7800
Mailing Address - Street 1:1603 HAMILL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4902
Mailing Address - Country:US
Mailing Address - Phone:423-877-7800
Mailing Address - Fax:423-876-8915
Practice Address - Street 1:1510 GUNBARREL RD STE 700
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7129
Practice Address - Country:US
Practice Address - Phone:423-648-4164
Practice Address - Fax:423-877-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3038332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3038OtherLICENSE
GA903791283AMedicaid
TN4118973OtherBCBS OF TN PROVIDER NUMBE
3038OtherLICENSE