Provider Demographics
NPI:1659913226
Name:BLACK BEAR MEDICAL LLC
Entity Type:Organization
Organization Name:BLACK BEAR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-663-3947
Mailing Address - Street 1:7003 CHADWICK DR STE 211
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5232
Mailing Address - Country:US
Mailing Address - Phone:615-663-3947
Mailing Address - Fax:
Practice Address - Street 1:7003 CHADWICK DR STE 211
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5232
Practice Address - Country:US
Practice Address - Phone:615-663-3947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies