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General NPI Number Information
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NPI Number | 1063865962
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Entity Type | Organization
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Legal Business Name | DOWELL SPRINGS MEDICAL LLC.
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6908 HOSPITALITY CIR STE B
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City | KNOXVILLE
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State | TN
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Zip | 37909-1105
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Country | US
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Telephone | 865-444-1200
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Fax | 865-862-4878
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Provider Business Mailing Address
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Address Line | PO BOX 2107
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City | MORRISTOWN
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State | TN
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Zip | 37816-2107
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Country | US
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Telephone | 423-581-1118
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Fax | 423-581-1104
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RANDALL BOYD DEBORD SR.
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Credential | C.PED., L.PED., CFO.
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Telephone | 423-312-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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