Organization Name: | FREDS STORES OF TENNESSEE INC |
NPI Number: | 1114233343 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICKY CHAMBERS (VP) |
Mailing Address: | 7818 Highway 613 Moss Point |
State: | MS US |
Postal Code: | 395639315 |
Phone Number: | 2284756912 |
Fax Number: | |
NPI Enumeration Date: | 08/25/2010 |
NPI Last Update Date: | 12/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 00988012 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |