MEDICARE: BEI BRUH THA 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1710161542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEI BRUH THA LLC

Provider Business Mailing Address
First Line	:	2000 MALLORY LN
Second Line	:	SUITE 615
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8209
Country	:	US
Telephone Number	:	615-771-7890
Fax Number	:	615-771-7839

Provider Business Practice Location Address
First Line	:	2000 MALLORY LN
Second Line	:	SUITE 615
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8209
Country	:	US
Telephone Number	:	615-771-7890
Fax Number	:	615-771-7839

Authorized Official
Title or Position	:	OWNER
Name	:	AURDIE AMOO ASANTE
Credential	:	PEDORTHIST
Telephone Number	:	615-771-7890

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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Directions to “BEI BRUH THA LLC ” Practice Location

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