Provider Demographics
NPI:1740402296
Name:MEDICAL EQUIPMENT DISTRIBUTORS OF TENESSEE
Entity Type:Organization
Organization Name:MEDICAL EQUIPMENT DISTRIBUTORS OF TENESSEE
Other - Org Name:MEDICAL MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-380-0819
Mailing Address - Street 1:742 W LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801
Mailing Address - Country:US
Mailing Address - Phone:865-380-0819
Mailing Address - Fax:865-380-0890
Practice Address - Street 1:980 HIGHWAY 28
Practice Address - Street 2:SUITE 404
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3695
Practice Address - Country:US
Practice Address - Phone:423-942-2556
Practice Address - Fax:423-942-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000691332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454237Medicaid
TN1454237Medicaid