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General NPI Number Information
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NPI Number | 1699841619
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Entity Type | Organization
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Legal Business Name | SMOKEY MOUNTAIN MEDICAL EQUIPMENT LLC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 2214 W ELK AVE
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City | ELIZABETHTON
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State | TN
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Zip | 37643-3714
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Country | US
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Telephone | 423-547-0060
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Fax | 423-547-0064
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Provider Business Mailing Address
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Address Line | 2214 W ELK AVE
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City | ELIZABETHTON
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State | TN
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Zip | 37643-3714
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Country | US
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Telephone | 423-547-0060
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Fax | 423-547-0064
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | MR. CHARLES EDWARD PEARCE JR.
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Credential |
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Telephone | 423-547-0060
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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 | 000002328
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License Number State | TN
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