MEDICARE: BRADLEY DME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0000001364	TN

General Provider Information

NPI Number	:	1073547907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY DME LLC

Provider Business Mailing Address
First Line	:	220 W GERMANTOWN PIKE STE 250
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 S LEE HWY
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-7328
Country	:	US
Telephone Number	:	423-472-4300
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHEN P GRIGGS
Credential	:
Telephone Number	:	407-206-0040

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	10/18/2021

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