Provider Demographics
NPI:1760455430
Name:DARYL DONEY
Entity Type:Organization
Organization Name:DARYL DONEY
Other - Org Name:DARYL B. DONEY DBA MTR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:931-962-0234
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324
Mailing Address - Country:US
Mailing Address - Phone:931-962-0234
Mailing Address - Fax:931-962-0281
Practice Address - Street 1:2866 DECHERD BLVD.
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324
Practice Address - Country:US
Practice Address - Phone:931-962-0234
Practice Address - Fax:931-962-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN936332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454275Medicaid
TN1454275Medicaid