Healthcare Provider Details

I. General information

NPI: 1871542118
Provider Name (Legal Business Name): DIRECT MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7285 WINCHESTER RD SUITE 104
MEMPHIS TN
38125-2164
US

IV. Provider business mailing address

7285 WINCHESTER RD SUITE 104
MEMPHIS TN
38125-2164
US

V. Phone/Fax

Practice location:
  • Phone: 901-737-5069
  • Fax: 901-737-5078
Mailing address:
  • Phone: 901-737-5069
  • Fax: 901-737-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number617
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number617
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number617
License Number StateTN

VIII. Authorized Official

Name: MR. ROBERT EARL WILLIAMS
Title or Position: GENERAL MANAGER
Credential: C-PED
Phone: 901-737-5069