Healthcare Provider Details

I. General information

NPI: 1609968221
Provider Name (Legal Business Name): AT HOME MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 WALLACE RD
NASHVILLE TN
37211-4883
US

IV. Provider business mailing address

350 WALLACE RD
NASHVILLE TN
37211-4883
US

V. Phone/Fax

Practice location:
  • Phone: 615-333-3392
  • Fax: 615-333-3810
Mailing address:
  • Phone: 615-333-3392
  • Fax: 615-333-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0000002400
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: FRUZ ROSHAN
Title or Position: PRESIDENT
Credential:
Phone: 615-333-3392