Basic Information
| Provider Information | |||||||||
| NPI: | 1295719490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXTENDED CARE PRODUCTS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ECP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 NORTHPARK DR | ||||||||
| Address2: | SUITE 2F | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376043100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239755455 | ||||||||
| FaxNumber: | 4239755405 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 NORTHPARK DR | ||||||||
| Address2: | SUITE 2F | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376043100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239755455 | ||||||||
| FaxNumber: | 4239755405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | JIMMY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4239755455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 90262494 | 05 | KY | MEDICAID | 3562745 | 05 | TN | MEDICAID |