Provider Demographics
NPI:1790781201
Name:S & J SICKROOM SUPPLY, INC
Entity Type:Organization
Organization Name:S & J SICKROOM SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-629-7282
Mailing Address - Street 1:2400 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3301
Mailing Address - Country:US
Mailing Address - Phone:423-629-7283
Mailing Address - Fax:423-698-1038
Practice Address - Street 1:2400 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3301
Practice Address - Country:US
Practice Address - Phone:423-629-7283
Practice Address - Fax:423-698-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN613332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3541588Medicaid
TN3541588Medicaid