Provider Demographics
NPI:1811030331
Name:CAREMAX PHARMACY OF LOUDON, INC
Entity Type:Organization
Organization Name:CAREMAX PHARMACY OF LOUDON, INC
Other - Org Name:CAREMAX HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF STRATEGY OFFICER/EVP
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1050
Mailing Address - Street 1:17111 PRESTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1234
Mailing Address - Country:US
Mailing Address - Phone:866-972-5888
Mailing Address - Fax:664-915-8888
Practice Address - Street 1:413 S GAY ST STE 203
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37902-1104
Practice Address - Country:US
Practice Address - Phone:865-540-1002
Practice Address - Fax:866-491-5888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAGON HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 332BP3500X, 3336H0001X, 3336S0011X
TN830332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520188Medicaid
KY7100314000Medicaid
TN1452831Medicaid