MEDICARE: CHEROKEE HEALTH CARE 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)	673	TN
2	332B00000X	Durable Medical Equipment & Medical Supplies	673	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	0049062	OTHER	TN	BCBS/TENNCARE PROV #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689603532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEROKEE HEALTH CARE SUPPLY INC

Provider Business Mailing Address
First Line	:	1690 25TH ST NW
Second Line	:	SUITE B
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3613
Country	:	US
Telephone Number	:	423-559-3010
Fax Number	:	423-559-3011

Provider Business Practice Location Address
First Line	:	1690 25TH ST NW
Second Line	:	SUITE B
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3613
Country	:	US
Telephone Number	:	423-559-3010
Fax Number	:	423-559-3011

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. RICKY FORSHEE
Credential	:
Telephone Number	:	423-559-3010

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	02/16/2018

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Directions to “CHEROKEE HEALTH CARE SUPPLY INC ” Practice Location

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