Provider Demographics
NPI:1194087619
Name:HARVEY DURHAM HOME MEDICAL, LLC
Entity type:Organization
Organization Name:HARVEY DURHAM HOME MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-739-5831
Mailing Address - Street 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SKYLINE MEDICAL PLAZA, SUITE G-20
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2519
Mailing Address - Country:US
Mailing Address - Phone:915-739-5831
Mailing Address - Fax:
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SKYLINE MEDICAL PLAZA, SUITE G-20
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:915-739-5831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARVEY DURHAM MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI000000010157253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care