Provider Demographics
NPI:1700869625
Name:MID AMERICA MEDICAL SUPPLY OF TENNESSEE LP
Entity Type:Organization
Organization Name:MID AMERICA MEDICAL SUPPLY OF TENNESSEE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN, METRO MEDICAL SUPPLY, INC
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-312-9880
Mailing Address - Street 1:200 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1804
Mailing Address - Country:US
Mailing Address - Phone:615-312-9880
Mailing Address - Fax:615-320-5418
Practice Address - Street 1:766 TENNESSEE AVE S
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-4607
Practice Address - Country:US
Practice Address - Phone:731-847-3150
Practice Address - Fax:731-847-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000409332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3560150Medicaid
0465050001Medicare ID - Type Unspecified