Provider Demographics
NPI:1740588193
Name:ECLIPSE MEDICAL
Entity Type:Organization
Organization Name:ECLIPSE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALISBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CCM
Authorized Official - Phone:423-531-2871
Mailing Address - Street 1:3700 BRAINERD RD
Mailing Address - Street 2:SUITES 34A 34B
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3603
Mailing Address - Country:US
Mailing Address - Phone:423-531-2871
Mailing Address - Fax:423-531-2872
Practice Address - Street 1:3700 BRAINERD RD
Practice Address - Street 2:SUITES 34A 34B
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3603
Practice Address - Country:US
Practice Address - Phone:423-531-2871
Practice Address - Fax:423-531-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6535490001Medicare NSC