Provider Demographics
NPI:1275518847
Name:WILLIAMS MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:WILLIAMS MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-375-1775
Mailing Address - Street 1:5410 HOMBERG DR STE 16
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5029
Mailing Address - Country:US
Mailing Address - Phone:888-211-2411
Mailing Address - Fax:615-321-5287
Practice Address - Street 1:5410 HOMBERG DR STE 16
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5029
Practice Address - Country:US
Practice Address - Phone:888-211-2411
Practice Address - Fax:615-321-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2002209OtherBLUE CROSS PROVIDER NUMBE
TN3521302Medicaid
TN0162740001Medicare PIN
TN3521302Medicaid