Lucky Strike Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LUCKY STRIKE MEDICAL SUPPLY INC

Practice address

2258 W Broad St Unit 1
Cookeville, TN 38501-2263

Phone

(931) 854-0686

Fax

(931) 854-0692

NPI assigned

May 25, 2023

Last updated

May 25, 2023By 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. Ehimwenma K Owen

Title

Managing Director

Phone

(502) 291-4542

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1245922327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2258 W BROAD ST UNIT 1",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012263",
            "telephone_number": "931-854-0686",
            "fax_number": "931-854-0692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2258 W BROAD ST UNIT 1",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012263",
            "telephone_number": "931-854-0686",
            "fax_number": "931-854-0692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCKY STRIKE MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-25",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "EHIMWENMA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "502-291-4542",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Lovell, LCSW
• Sherrie Lynn Lowe
• LP Cookeville, LLC (Signature HealthCARE of Putnam County)
• Phillip H Lucas, M.D.
• Shelby Leigh Ann Lucas
• Margarita Lundhom
• Tara Luther, SLP-CCC
• Luxottica Retail North America Inc (Sears Optical #C1082)
• Annette J Lynch, LPC-MHSP
• Karen Yvonne Lynn, FAMILY NURSE PRACTIT

• Durable Medical Equipment & Medical Supplies in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Durable Medical Equipment & Medical Supplies in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.