Healthcare Provider Details

I. General information

NPI: 1093851362
Provider Name (Legal Business Name): AFFINITY REHAB AND MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4937 HIGHWAY 43 N SUITE 101
SUMMERTOWN TN
38483-7052
US

IV. Provider business mailing address

4937 HIGHWAY 43 N SUITE 101
SUMMERTOWN TN
38483-7052
US

V. Phone/Fax

Practice location:
  • Phone: 931-964-0880
  • Fax: 931-964-0886
Mailing address:
  • Phone: 931-964-0880
  • Fax: 931-964-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. CHRISTOPHER MORAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 931-964-0880