Healthcare Provider Details

I. General information

NPI: 1396805438
Provider Name (Legal Business Name): BRAXTEN HOME CARE MEDICAL EQUIPMENT, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10579 CEDAR GROVE RD SUITE 150
SMYRNA TN
37167-8376
US

IV. Provider business mailing address

10579 CEDAR GROVE RD SUITE 150
SMYRNA TN
37167-8376
US

V. Phone/Fax

Practice location:
  • Phone: 615-220-5609
  • Fax: 615-220-5722
Mailing address:
  • Phone: 615-220-5609
  • Fax: 615-220-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0000002171
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0000002171
License Number StateTN

VIII. Authorized Official

Name: MR. ROD PENCEK
Title or Position: OWNER
Credential:
Phone: 615-220-5609