Healthcare Provider Details

I. General information

NPI: 1689297442
Provider Name (Legal Business Name): FREEDOM 2 GO BIOMED & PERMITTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 COTTONWOOD RD STE 1A
MEMPHIS TN
38118-2609
US

IV. Provider business mailing address

5308 COTTONWOOD RD STE 1A
MEMPHIS TN
38118-2609
US

V. Phone/Fax

Practice location:
  • Phone: 901-566-0540
  • Fax:
Mailing address:
  • Phone: 901-566-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. TONDA BARDWELL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 601-566-0540