Provider Demographics
NPI:1699841619
Name:SMOKEY MOUNTAIN MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:SMOKEY MOUNTAIN MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-547-0060
Mailing Address - Street 1:2214 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3714
Mailing Address - Country:US
Mailing Address - Phone:423-547-0060
Mailing Address - Fax:423-547-0064
Practice Address - Street 1:2214 W ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3714
Practice Address - Country:US
Practice Address - Phone:423-547-0060
Practice Address - Fax:423-547-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000002328332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454924Medicaid
TN4100472OtherBCBS
TN4100472OtherBCBS