MR. MALCOLM RANDALL QUATTLEBAUM (NPI# 1255456661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255456661 |
| Entity Type | Individual |
| Full Name | MR. MALCOLM RANDALL QUATTLEBAUM |
| Practice Address |
3090 Fm 317 Athens TX 75752-5796 |
| Practice Telephone | 9036755900 |
| Practice Fax Number | 9036755900 |
| Mailing Telephone | 9036755900 |
| Mailing Fax Number | 9036755900 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2009-01-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | 0079342 | TX | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BLUE CROSS BLUE SHIELD | 507686 | 01 |
| Street Address |
3090 FM 317 |
| City | ATHENS |
| State | TX |
| Zip Code | 75752-5796 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730190851 | Glenna Miller White | Counselor | 74070 F M 317, Athens, TX 75752 | 2006-08-11 |
| 1821064742 | Andrews Center | Counselor | 6901 S. Hwy 19, Athens, TX 75752 | 2006-02-28 |
| 1134120256 | Mark L Eldore | Obstetrics & Gynecology | 824 Southpark Circle, Athens, TX 75752 | 2005-08-10 |
| 1720534449 | Nurture Community Healthcare Center | Skilled Nursing Facility | 110 Waverly Way, Athens, TX 75752 | 2016-09-01 |
| 1831107028 | Mark L Eldore Md Pllc | Nurse Practitioner | 824 Southpark Circle, Athens, TX 75752 | 2006-08-03 |
| 1629044557 | Timothy Furlong | Psychiatry & Neurology | 6901 S. Hwy 19, Athens, TX 75752 | 2006-02-28 |
| 1003281999 | South Van Zandt Volunteer Fire Department, Inc | Emergency Medical Technician, Basic | 26306 State Highway 19 N, Athens, TX 75752-3704 | 2015-12-03 |
| 1780608323 | Andrwes Center/ Athens Place | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4875 Fm 2709, Athens, TX 75752-3807 | 2006-07-27 |
| 1063481380 | Kathy Wakefield | Counselor | 6091 State Highway 19 N, Athens, TX 75752-3983 | 2006-03-17 |
| 1770947186 | Joshua Cahan Felts | Specialist | 5900 County Road 3704, Athens, TX 75752-5045 | 2016-04-12 |
| Find all providers in zip 75752 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881245926 | First Care Health Pllc | Durable Medical Equipment & Medical Supplies | 509c W Madison Ave, Athens, TN 37303-3489 | 2019-09-20 |
| 1588122394 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 1101 Old Creek Rd Ste A1, Athens, GA 30607-1090 | 2019-03-11 |
| 1164883757 | Georgia Cvs Pharmacy L L C | Durable Medical Equipment & Medical Supplies | 170 West Broad St, Athens, GA 30601-2815 | 2016-03-10 |
| 1750747432 | Dme Assistance | Durable Medical Equipment & Medical Supplies | 355 Sarah Dr, Athens, GA 30606-1674 | 2016-01-11 |
| 1043681604 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 3130 Atlanta Hwy, Athens, GA 30606-6977 | 2015-10-08 |
| 1467834119 | Aaa Medical Equipment & Supply, Inc | Durable Medical Equipment & Medical Supplies | 22923 Us Highway 72 Ste C, Athens, AL 35613 | 2015-06-18 |
| 1972984813 | Scooter Repair Center Plus | Durable Medical Equipment & Medical Supplies | 4719 Atlanta Hwy, Athens, GA 30606-0716 | 2015-06-16 |
| 1528448883 | Mobility Repair Medical | Durable Medical Equipment & Medical Supplies | 315 E Meadow Dr, Athens, GA 30605-6204 | 2015-06-02 |
| 1710392980 | Physicians American Medical | Durable Medical Equipment & Medical Supplies | 571 Whitehead Rd Unit 3, Athens, GA 30606 | 2014-06-26 |
| 1619397478 | The Kroger Co | Durable Medical Equipment & Medical Supplies | 700 Highway 29 N, Athens, GA 30601 | 2014-04-21 |
| Find all providers in ATHENS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.