Type 2

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

044113 Issued in TN

Legal business name

TYPE 2

Practice address

5793 Brainerd Rd
Chattanooga, TN 37411-4011

Phone

(423) 834-6699

Fax

(423) 499-6408

NPI assigned

Mar 9, 2012

Last updated

Mar 9, 2012By 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. Michee Gustave

Title

Owner

Phone

(423) 834-6699

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331251200000",
    "number": "1346515343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5406 AUTUMN WOOD DR",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374161553",
            "telephone_number": "423-834-6699",
            "fax_number": "423-344-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5793 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374114011",
            "telephone_number": "423-834-6699",
            "fax_number": "423-499-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYPE 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-09",
        "last_updated": "2012-03-09",
        "status": "A",
        "authorized_official_last_name": "GUSTAVE",
        "authorized_official_first_name": "MICHEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-834-6699",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "044113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Chattanooga, TN
• Providers in Chattanooga, 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 Mar 9, 2012; 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.