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General NPI Number Information
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NPI Number | 1255139093
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Entity Type | Organization
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Legal Business Name | HAVEN HOME MEDICAL GROUP LLC
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 118 W WALNUT ST
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City | SMITHVILLE
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State | TN
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Zip | 37166-1326
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Country | US
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Telephone | 615-979-9453
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Fax |
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Provider Business Mailing Address
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Address Line | 4632 SPARTA HWY
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City | SMITHVILLE
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State | TN
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Zip | 37166-5158
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Country | US
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Telephone | 615-979-9453
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DONALD BLASCHKKE
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Credential | MD
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Telephone | 615-979-9453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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