Provider Demographics
NPI:1841779105
Name:ANTIOCH MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ANTIOCH MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EFE
Authorized Official - Middle Name:K
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-403-2916
Mailing Address - Street 1:304 S LOWRY ST STE A4
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3493
Mailing Address - Country:US
Mailing Address - Phone:615-625-3332
Mailing Address - Fax:615-984-4082
Practice Address - Street 1:304 S LOWRY ST STE A4
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3493
Practice Address - Country:US
Practice Address - Phone:615-625-3332
Practice Address - Fax:615-984-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDMEHS4340332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDMHS4340OtherDMHS