Bise, LLC
Organization Active NPI Community/Retail Pharmacy · Surgoinsville, TN
NPI 1619225950 · NPPES record last updated Aug 16, 2012
Key facts
- NPI
- 1619225950
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 4667 (TN)
- Legal business name
- BISE, LLC
- Practice address
- 114 Bellamy Avenue
Surgoinsville, TN 37873 - Phone
- (423) 345-0333
- Fax
- (423) 345-0336
- NPI assigned
- Aug 16, 2012
- Organization subpart
- No
Authorized official
- Name
- Beth Bryan, PHARMD
- Title
- Owner/Manager
- Phone
- (423) 345-0333
Corporate family (same tax ID) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190323000022 | TN | Part B Supplier - Pharmacy | 4587904867 | Practice locations: Surgoinsville, TN |
| O20200610003508 | TN | Part B Supplier - Independent Clinical Laboratory | 4587904867 | Practice locations: Surgoinsville, TN |
| O20220930002840 | TN | MDPP Supplier - in-Person MDPP Supplier | 4587904867 | Practice locations: Surgoinsville, TN |
National Provider Directory
- Tax ID family
- Bise LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 4667 | TN | Yes |
Addresses
Primary practice location
114 Bellamy Avenue
Surgoinsville, TN 37873
Mailing address
114 Bellamy Avenue
Surgoinsville, TN 37873
Phone (423) 345-0333
Other names
- Surgoinsville Pharmacy
Other providers in Surgoinsville, TN
All providers in Surgoinsville, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.