Provider Demographics
NPI:1285078717
Name:ENTERAL PRODUCTS LLC
Entity type:Organization
Organization Name:ENTERAL PRODUCTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:YISOREL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:RECHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-863-9266
Mailing Address - Street 1:1760 MORIAH WOODS BLVD
Mailing Address - Street 2:2-B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7128
Mailing Address - Country:US
Mailing Address - Phone:877-863-9266
Mailing Address - Fax:901-260-5202
Practice Address - Street 1:1760 MORIAH WOODS BLVD
Practice Address - Street 2:2-B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7128
Practice Address - Country:US
Practice Address - Phone:877-863-9266
Practice Address - Fax:901-260-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000001161332B00000X
AZC000958332B00000X
ARMG01489332B00000X
CA73161332B00000X
CTCSW.0003218332B00000X
IDDME34534332B00000X
KYHME00761332B00000X
LADME.000518332B00000X
MDR3457332B00000X
NVMP01209332B00000X
ORNPC0004081332B00000X
PA6000008495332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6147890003Medicare NSC