Provider Demographics
NPI:1447624481
Name:CERTIFIED MEDICAL STAFFING, LLC
Entity type:Organization
Organization Name:CERTIFIED MEDICAL STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-496-9210
Mailing Address - Street 1:5219 SUMMER MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9594
Mailing Address - Country:US
Mailing Address - Phone:901-496-9210
Mailing Address - Fax:901-317-7025
Practice Address - Street 1:5219 SUMMER MEADOWS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9594
Practice Address - Country:US
Practice Address - Phone:901-496-9210
Practice Address - Fax:901-317-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000015644253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445881Medicaid