Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 332BX2000X | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 0000000501 | TENNESSEE | No |
| 2 | 3336C0002X | Pharmacy | Clinic Pharmacy | 0000003198 | TENNESSEE | No |
| 3 | 332B00000X | Durable Medical Equipment & Medical Supplies | | 0000000501 | TENNESSEE | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | ========= | OTHER | KENTUCKY | BLUE CROSS BLUE SHIELD |
| 2 | ========= | OTHER | TENNESSEE | US DEPARTMENT OF LABOR |
| 3 | ========= | OTHER | TENNESSEE | NATIONAL FOUNDATION LIFE |
| 4 | ========= | OTHER | TENNESSEE | WAUSAU |
| 5 | 3537453 | MEDICAID | TENNESSEE | |
| 6 | 0026855 | OTHER | TENNESSEE | BLUE CROSS BLUE SHIELD |
| 7 | 1401120 | OTHER | TENNESSEE | HEALTH SPRING |
| 8 | ========= | OTHER | TENNESSEE | FORTIS |
| 9 | ========= | OTHER | TENNESSEE | NASHVILLE ELECTRIC SERVIC |
| 10 | ========= | OTHER | TENNESSEE | UNITED HEALTH CARE |
| 11 | 0144850001 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | |
| 12 | ========= | OTHER | ALABAMA | BLUE CROSS BLUE SHIELD |
| 13 | ========= | OTHER | | TRICARE REGIONS 3-4 |
| 14 | ========= | OTHER | TENNESSEE | MAIL HANDLERS |
| 15 | ========= | OTHER | TENNESSEE | TRAVELERS |
| 16 | ========= | OTHER | TENNESSEE | TECO |
| 17 | ========= | OTHER | TENNESSEE | AETNA |
| 18 | ========= | OTHER | TENNESSEE | HOMELINK |
| 19 | ========= | OTHER | TENNESSEE | BLACK LUNG |
| 20 | ========= | OTHER | TENNESSEE | CIGNA HEALTHCARE |
| 21 | 0144850004 | MEDICARE NSC | NORTH CAROLINA | |
