Provider Demographics
NPI:1013956077
Name:CCC MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:CCC MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEDMON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:731-584-7919
Mailing Address - Street 1:115 VICKSBURG AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1636
Mailing Address - Country:US
Mailing Address - Phone:731-584-7919
Mailing Address - Fax:731-584-7920
Practice Address - Street 1:115 VICKSBURG AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1613
Practice Address - Country:US
Practice Address - Phone:731-584-7919
Practice Address - Fax:731-584-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN878332B00000X
TN00878332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455003Medicaid
TN6001870001Medicare NSC