Provider Demographics
NPI:1780736801
Name:MAJOR MEDICAL EQUIPMENT CO OF CHATTANOOGA
Entity type:Organization
Organization Name:MAJOR MEDICAL EQUIPMENT CO OF CHATTANOOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FABISH
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:423-842-7269
Mailing Address - Street 1:6619 WHITE SANDS LANE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3184
Mailing Address - Country:US
Mailing Address - Phone:423-842-7269
Mailing Address - Fax:423-842-7269
Practice Address - Street 1:6619 WHITE SANDS LANE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3184
Practice Address - Country:US
Practice Address - Phone:423-842-7269
Practice Address - Fax:423-842-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43096800332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1158050001Medicaid
TN1158050001Medicaid
TN1158050001Medicare ID - Type Unspecified