| Organization Name: | DOC SUPPLY OF WEST TENNESSEE, LLC |
| NPI Number: | 1265764088 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT THOMAS BALDRIDGE (OWNER) |
| Mailing Address: | 39 Three Way Ln Suite A Humboldt |
| State: | TN US |
| Postal Code: | 383438561 |
| Phone Number: | 8003065160 |
| Fax Number: | 8004811206 |
| NPI Enumeration Date: | 02/03/2010 |
| NPI Last Update Date: | 04/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 1014 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |