MEDICARE: AT HOME MEDICAL SUPPLY, INC.

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	332BX2000X	Oxygen Equipment & Supplies (DME)	0000000824	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2639857	OTHER	TN	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	3121711	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1275539041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	1749 FLORIDA ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-1957
Country	:	US
Telephone Number	:	901-452-8770
Fax Number	:	901-452-9943

Provider Business Practice Location Address
First Line	:	1749 FLORIDA ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-1957
Country	:	US
Telephone Number	:	901-452-8770
Fax Number	:	901-452-9943

Authorized Official
Title or Position	:	CFO
Name	:	MRS. MARSHA MCNAIR
Credential	:
Telephone Number	:	901-452-8770

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/09/2011

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