Healthcare Provider Details

I. General information

NPI: 1689603532
Provider Name (Legal Business Name): CHEROKEE HEALTH CARE SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 25TH ST NW SUITE B
CLEVELAND TN
37311-3613
US

IV. Provider business mailing address

1690 25TH ST NW SUITE B
CLEVELAND TN
37311-3613
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-3010
  • Fax: 423-559-3011
Mailing address:
  • Phone: 423-559-3010
  • Fax: 423-559-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number673
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number673
License Number StateTN

VIII. Authorized Official

Name: MR. RICKY FORSHEE
Title or Position: VICE PRESIDENT
Credential:
Phone: 423-559-3010