Provider Demographics
NPI:1740454636
Name:DYERSBURG UNIFORM SHOPPE
Entity type:Organization
Organization Name:DYERSBURG UNIFORM SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOMMYE
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:JOSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-285-1778
Mailing Address - Street 1:2455 LAKE RD
Mailing Address - Street 2:DYERSBURG UNIFORM SHOPPE
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024
Mailing Address - Country:US
Mailing Address - Phone:731-285-1778
Mailing Address - Fax:731-285-1766
Practice Address - Street 1:2455 LAKE RD
Practice Address - Street 2:DYERSBURG UNIFORM SHOPPE
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-285-1778
Practice Address - Fax:731-285-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5704650001Medicare NSC