=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679807887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORLD OF INDEPENDENCE DYNAMIC CONVERSIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2009
-----------------------------------------------------
Last Update Date | 09/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8742 ASHEVILLE HWY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37924-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-932-2880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8742 ASHEVILLE HWY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37924-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-932-2880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LESLIE DALE BROOKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-932-2880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------