Provider Demographics
NPI:1912177437
Name:BROC MEDICAL SUPPLY CO.
Entity Type:Organization
Organization Name:BROC MEDICAL SUPPLY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-366-6754
Mailing Address - Street 1:5968 KNIGHT ARNOLD ROAD EXT
Mailing Address - Street 2:SUITE 300 A
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-3251
Mailing Address - Country:US
Mailing Address - Phone:901-366-6754
Mailing Address - Fax:901-366-6756
Practice Address - Street 1:5968 KNIGHT ARNOLD ROAD EXT
Practice Address - Street 2:SUITE 300 A
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-3251
Practice Address - Country:US
Practice Address - Phone:901-366-6754
Practice Address - Fax:901-366-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies