MEDICARE: MEMPHIS DME SUPPLY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1467288795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMPHIS DME SUPPLY LLC

Provider Business Mailing Address
First Line	:	5118 PARK AVE STE 323
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-5711
Country	:	US
Telephone Number	:	800-695-5474
Fax Number	:	901-443-1196

Provider Business Practice Location Address
First Line	:	5118 PARK AVE STE 323
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-5711
Country	:	US
Telephone Number	:	800-695-5474
Fax Number	:	901-443-1196

Authorized Official
Title or Position	:	OWNER
Name	:	ROLAND KARTLELISHVILI
Credential	:
Telephone Number	:	800-695-5474

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	03/18/2026

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