Provider Demographics
NPI:1538310776
Name:AMMED DIRECT, LLC
Entity type:Organization
Organization Name:AMMED DIRECT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-941-3500
Mailing Address - Street 1:5720 CROSSINGS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3144
Mailing Address - Country:US
Mailing Address - Phone:615-941-3800
Mailing Address - Fax:615-941-3598
Practice Address - Street 1:5720 CROSSINGS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3144
Practice Address - Country:US
Practice Address - Phone:615-941-3800
Practice Address - Fax:615-941-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41283336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4438001Medicaid
4443240002Medicare NSC