Affinity Rehab and Medical Supply, LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

AFFINITY REHAB AND MEDICAL SUPPLY, LLC

Practice address

4937 Highway 43 N
Suite 101
Summertown, TN 38483-7052

Phone

(931) 964-0880

Fax

(931) 964-0886

NPI assigned

Jan 30, 2007

Last updated

Nov 19, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Christopher Moran

Title

Chief Financial Officer

Phone

(931) 964-0880

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1093851362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4937 HIGHWAY 43 N",
            "address_2": "SUITE 101",
            "city": "SUMMERTOWN",
            "state": "TN",
            "postal_code": "384837052",
            "telephone_number": "931-964-0880",
            "fax_number": "931-964-0886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4937 HIGHWAY 43 N",
            "address_2": "SUITE 101",
            "city": "SUMMERTOWN",
            "state": "TN",
            "postal_code": "384837052",
            "telephone_number": "931-964-0880",
            "fax_number": "931-964-0886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINITY REHAB AND MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "931-964-0880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455157",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP COMMUNITY CARE",
            "identifier": "1053538",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "4153548",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Trever Calvert

• Customized Equipment (DME) in Summertown, TN
• Providers in Summertown, TN by specialty
• Customized Equipment (DME) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.