Provider Demographics
NPI:1760680284
Name:MEDICAL DIRECT CLUB, LLC
Entity Type:Organization
Organization Name:MEDICAL DIRECT CLUB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:GULMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-945-0066
Mailing Address - Street 1:2026 LINDELL AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5509
Mailing Address - Country:US
Mailing Address - Phone:800-945-0066
Mailing Address - Fax:615-628-0453
Practice Address - Street 1:2026 LINDELL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5509
Practice Address - Country:US
Practice Address - Phone:800-945-0066
Practice Address - Fax:615-628-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN154329332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6005570001Medicare NSC