Basic Information
| Provider Information | |||||||||
| NPI: | 1053313833 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARR REHAB INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 746 N HALL OF FAME DR | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379176721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462386 | ||||||||
| FaxNumber: | 8655462598 | ||||||||
| Practice Location | |||||||||
| Address1: | 746 N HALL OF FAME DR | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379176721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462386 | ||||||||
| FaxNumber: | 8655462598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CARR | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8655462386 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 0000000677 | TN | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0124267 | 01 | TN | BLUE CROSS OF TN - DME | OTHER | 3560673 | 05 | TN | MEDICAID |