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General NPI Number Information
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NPI Number | 1780048736
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Entity Type | Organization
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Legal Business Name | MEDVED & LEBED INC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 2412 W ANDREW JOHNSON HWY SUITE E
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City | MORRISTOWN
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State | TN
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Zip | 37814-3276
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Country | US
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Telephone | 423-587-5800
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Fax | 423-587-5818
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Provider Business Mailing Address
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Address Line | 2412 W ANDREW JOHNSON HWY SUITE E
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City | MORRISTOWN
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State | TN
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Zip | 37814-3276
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Country | US
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Telephone | 423-587-5800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRADFORD A OTTENS
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Credential |
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Telephone | 423-587-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | I000000017907
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License Number State | TN
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