Provider Demographics
NPI:1699921486
Name:EARL B. CAMERON JR.
Entity type:Organization
Organization Name:EARL B. CAMERON JR.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-614-5962
Mailing Address - Street 1:330 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5923
Mailing Address - Country:US
Mailing Address - Phone:423-614-5962
Mailing Address - Fax:423-479-3133
Practice Address - Street 1:330 3RD ST SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5923
Practice Address - Country:US
Practice Address - Phone:423-614-5962
Practice Address - Fax:423-479-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6273730001Medicare NSC