Healthcare Provider Details

I. General information

NPI: 1154400323
Provider Name (Legal Business Name): PARAGON MEDICAL ENTEPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 BELLFOUNTE RD NE
CLEVELAND TN
37312-6602
US

IV. Provider business mailing address

PO BOX 1301
CLEVELAND TN
37364-1301
US

V. Phone/Fax

Practice location:
  • Phone: 423-336-1651
  • Fax: 423-336-1597
Mailing address:
  • Phone: 423-336-1651
  • Fax: 423-336-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM JEROLD STOUT
Title or Position: PRESIDENT
Credential:
Phone: 423-336-1651