Provider Demographics
NPI:1215234521
Name:QUEEN OF HEARTS MEDICAL, INC
Entity type:Organization
Organization Name:QUEEN OF HEARTS MEDICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-380-5611
Mailing Address - Street 1:2965 N GERMANTOWN RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4055
Mailing Address - Country:US
Mailing Address - Phone:901-380-5610
Mailing Address - Fax:901-380-5611
Practice Address - Street 1:2965 N GERMANTOWN RD
Practice Address - Street 2:SUITE 112
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4055
Practice Address - Country:US
Practice Address - Phone:901-380-5610
Practice Address - Fax:901-380-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6586700001Medicare NSC