Provider Demographics
NPI:1689972960
Name:PARAGON NUTRITION CARE, LLC
Entity Type:Organization
Organization Name:PARAGON NUTRITION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-433-9799
Mailing Address - Street 1:115 MARKET ST E STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3092
Mailing Address - Country:US
Mailing Address - Phone:931-433-9799
Mailing Address - Fax:866-491-5888
Practice Address - Street 1:115 MARKET ST E STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3092
Practice Address - Country:US
Practice Address - Phone:931-433-9799
Practice Address - Fax:866-491-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition