Provider Demographics
NPI:1720549017
Name:MOCKINGBIRD DME LLC
Entity Type:Organization
Organization Name:MOCKINGBIRD DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-447-9060
Mailing Address - Street 1:200 W MARTIN LUTHER KING BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2571
Mailing Address - Country:US
Mailing Address - Phone:888-447-9060
Mailing Address - Fax:
Practice Address - Street 1:200 W MARTIN LUTHER KING BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2571
Practice Address - Country:US
Practice Address - Phone:888-447-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies