NPIMap

Organization Active NPI

Fuller Rehabilitation and Consulting Services Inc.

Doing business as Independent Living Aids

  • Durable Medical Equipment & Medical Supplies
  • Clarksville, TN
National Provider Identifier
1114026556
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
656 Issued in TN
Legal business name
FULLER REHABILITATION AND CONSULTING SERVICES INC.
Doing business as
Independent Living Aids
Practice address
1923 Madison St # C
Clarksville, TN 37043-5066
Phone
(931) 551-4445
Fax
(931) 551-4255
NPI assigned
Sep 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Wanda Patricia Mullis
Title
Vice President
Phone
(706) 965-3801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 656 TN Primary

Addresses

Primary practice location

1923 Madison St # C
Clarksville, TN 37043-5066

Mailing address

529 Rollins Industrial Blvd
P.O. Box 615
Ringgold, GA 30736-2872
Phone (706) 965-6131

Other identifiers 1

IdentifierTypeStateIssuer
4581852MedicaidTN

Other names 1

  • Independent Living Aids Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fuller Rehabilitation Consulting Services Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

529 Rollins Industrial Blvd
Ringgold, GA 30736
Phone (706) 965-6131

1923 Madison St
Ste C
Clarksville, TN 37043
Phone (931) 551-4445

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114026556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 ROLLINS INDUSTRIAL BLVD",
            "address_2": "P.O. BOX 615",
            "city": "RINGGOLD",
            "state": "GA",
            "postal_code": "307362872",
            "telephone_number": "706-965-6131",
            "fax_number": "706-965-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 MADISON ST # C",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370435066",
            "telephone_number": "931-551-4445",
            "fax_number": "931-551-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER REHABILITATION AND CONSULTING SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MULLIS",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "706-965-3801",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4581852",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independent Living Aids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.