Provider Demographics
NPI:1679756498
Name:HABAKKUK ENTERPRISES INC
Entity Type:Organization
Organization Name:HABAKKUK ENTERPRISES INC
Other - Org Name:HABAKKUK MEDICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-672-7289
Mailing Address - Street 1:2500 MOUNT MORIAH RD
Mailing Address - Street 2:BLDG H STE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-1523
Mailing Address - Country:US
Mailing Address - Phone:901-672-7289
Mailing Address - Fax:901-672-7356
Practice Address - Street 1:2500 MOUNT MORIAH RD
Practice Address - Street 2:BUILDING H SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1510
Practice Address - Country:US
Practice Address - Phone:901-672-7289
Practice Address - Fax:901-672-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN107000607332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6094490001Medicare NSC