1992705446 NPI number — VALLEY MEDICAL SUPPLIES, INC

Table of content: (NPI 1992705446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992705446 NPI number — VALLEY MEDICAL SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY MEDICAL SUPPLIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992705446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1024
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28359-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 MEDICAL DR STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-4442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-483-4897
Provider Business Practice Location Address Fax Number:
910-484-5496
Provider Enumeration Date:
07/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SHWETA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-483-4897

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  00963 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BX2000X , with the licence number: 00963 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , with the licence number: 00963 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7704245 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".