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General NPI Number Information
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NPI Number | 1750710331
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Entity Type | Organization
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Legal Business Name | CCC MEDICAL EQUIPMENT, INC.
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 205 HOSPITAL DR
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City | MC KENZIE
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State | TN
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Zip | 38201-1649
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Country | US
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Telephone | 731-352-6005
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Fax | 731-352-6006
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Provider Business Mailing Address
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Address Line | 115 VICKSBURG AVE
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City | CAMDEN
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State | TN
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Zip | 38320-1613
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Country | US
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Telephone | 731-584-7919
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Fax | 731-584-7920
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. BRENDA C MONTGOMERY
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Credential |
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Telephone | 731-584-7919
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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 | 00000000878
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License Number State | TN
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