Provider Demographics
NPI:1205082468
Name:CITY DRUG MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:CITY DRUG MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:731-989-7002
Mailing Address - Street 1:110 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2322
Mailing Address - Country:US
Mailing Address - Phone:731-989-7002
Mailing Address - Fax:731-989-9685
Practice Address - Street 1:110 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2322
Practice Address - Country:US
Practice Address - Phone:731-989-7002
Practice Address - Fax:731-989-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies