Provider Demographics
NPI:1841275989
Name:DEBERRYMEDICALEQUIPMENTSUPPLIERINC.
Entity type:Organization
Organization Name:DEBERRYMEDICALEQUIPMENTSUPPLIERINC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-369-0110
Mailing Address - Street 1:3865 VISCOUNT AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-6051
Mailing Address - Country:US
Mailing Address - Phone:901-369-0110
Mailing Address - Fax:901-369-0082
Practice Address - Street 1:3865 VISCOUNT AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-6051
Practice Address - Country:US
Practice Address - Phone:901-369-0110
Practice Address - Fax:901-369-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454986Medicaid
TN1454219Medicaid
TN1454986Medicaid