Provider Demographics
NPI:1881665180
Name:AMMED DIRECT LLC
Entity Type:Organization
Organization Name:AMMED DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-941-3500
Mailing Address - Street 1:5720 CROSSINGS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3144
Mailing Address - Country:US
Mailing Address - Phone:615-941-3500
Mailing Address - Fax:615-941-3822
Practice Address - Street 1:5720 CROSSINGS BLVD STE A
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3144
Practice Address - Country:US
Practice Address - Phone:615-941-3500
Practice Address - Fax:615-941-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000705332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06972708Medicaid
OH2440228Medicaid
GA253505018AMedicaid
AL00914325Medicaid
AR148472716Medicaid
CO98183532Medicaid
MI4568254Medicaid
LA1139181Medicaid
OK200036550AMedicaid
AZ480038Medicaid
VA009120122Medicaid
DE1000023876Medicaid
TX1617870-1Medicaid
WV6203062000Medicaid
MO626101703Medicaid
WI82263800Medicaid
TN1454373Medicaid
KY90007964Medicaid
MO626101703Medicaid
TN4443240001Medicare NSC