Healthcare Provider Details

I. General information

NPI: 1487760088
Provider Name (Legal Business Name): HERBISON MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MAIN ST
MC EWEN TN
37101-4590
US

IV. Provider business mailing address

PO BOX 9
MC EWEN TN
37101-0009
US

V. Phone/Fax

Practice location:
  • Phone: 931-582-7711
  • Fax:
Mailing address:
  • Phone: 931-582-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number663
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3815
License Number StateTN

VIII. Authorized Official

Name: MR. GEORGE ALLEN HERBISON
Title or Position: PRESIDENT
Credential:
Phone: 931-582-7711