Provider Demographics
NPI:1295719490
Name:EXTENDED CARE PRODUCTS INC
Entity type:Organization
Organization Name:EXTENDED CARE PRODUCTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-975-5455
Mailing Address - Street 1:2020 NORTHPARK DR
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3100
Mailing Address - Country:US
Mailing Address - Phone:423-975-5455
Mailing Address - Fax:423-975-5405
Practice Address - Street 1:2020 NORTHPARK DR
Practice Address - Street 2:SUITE 2F
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3100
Practice Address - Country:US
Practice Address - Phone:423-975-5455
Practice Address - Fax:423-975-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90262494Medicaid
TN3562745Medicaid
KY90262494Medicaid