Provider Demographics
NPI:1851591408
Name:MEDITRUST MEDICAL EQUIPMENT & SUPPLY,LLC
Entity Type:Organization
Organization Name:MEDITRUST MEDICAL EQUIPMENT & SUPPLY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-632-2166
Mailing Address - Street 1:716 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-2458
Mailing Address - Country:US
Mailing Address - Phone:731-632-2166
Mailing Address - Fax:731-632-2167
Practice Address - Street 1:716 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-2458
Practice Address - Country:US
Practice Address - Phone:731-632-2166
Practice Address - Fax:731-632-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN929332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455217Medicaid
TN1455217Medicaid