Provider Demographics
NPI:1871542118
Name:DIRECT MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:DIRECT MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:901-737-5069
Mailing Address - Street 1:7285 WINCHESTER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2164
Mailing Address - Country:US
Mailing Address - Phone:901-737-5069
Mailing Address - Fax:901-737-5078
Practice Address - Street 1:7285 WINCHESTER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2164
Practice Address - Country:US
Practice Address - Phone:901-737-5069
Practice Address - Fax:901-737-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN617332B00000X, 332BP3500X, 333300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4067605OtherBCBS TN PROVIDER NUMBER
TN1452535Medicaid
LA1467715Medicaid
TN4067605Medicaid
TNH445036OtherTN COMMISSION ON AGING
MS00440826Medicaid
TN24698Medicaid
TN25225Medicaid
AR49873OtherBCBS AR PROVIDER NUMBER
AR142674716Medicaid
TN144931Medicaid
MO5261409009Medicaid
KS392849OtherBCBS KS PROVIDER NUMBER
TN4067605Medicaid