MEDICARE: GORDON BEATS EARNHART AGAIN 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3021176	OTHER		BLUE CROSS TN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083680748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORDON BEATS EARNHART AGAIN LLC

Provider Business Mailing Address
First Line	:	37 N MAPLE ST
Second Line	:
City	:	HOHENWALD
State	:	TN
Zip	:	38462
Country	:	US
Telephone Number	:	931-796-7965
Fax Number	:	931-796-1176

Provider Business Practice Location Address
First Line	:	37 N MAPLE ST
Second Line	:
City	:	HOHENWALD
State	:	TN
Zip	:	38462
Country	:	US
Telephone Number	:	931-796-7965
Fax Number	:	931-796-1176

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH S HENSLEY
Credential	:
Telephone Number	:	931-796-7965

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	08/22/2020

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