Provider Demographics
NPI:1679672018
Name:FRIENDSHIP-ANGEL DME, INC.
Entity Type:Organization
Organization Name:FRIENDSHIP-ANGEL DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBUJOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-365-4424
Mailing Address - Street 1:333 PLUS PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-1132
Mailing Address - Country:US
Mailing Address - Phone:615-365-4424
Mailing Address - Fax:615-365-0998
Practice Address - Street 1:325 PLUS PARK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1032
Practice Address - Country:US
Practice Address - Phone:615-365-4424
Practice Address - Fax:615-365-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000766332B00000X
TN0000766332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000000766OtherHME/DME LICENSE
TN4139952OtherBCBS OF TN
TN1455108Medicaid
TN5766130001Medicare ID - Type Unspecified
TN1455108Medicaid