1023088432 NPI number — LOCKLEAR MEDICAL SUPPLIES,INC

Table of content: (NPI 1023088432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023088432 NPI number — LOCKLEAR MEDICAL SUPPLIES,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOCKLEAR 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:
6
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:
1023088432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 N PATTERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAXTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28364-1735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-844-1001
Provider Business Mailing Address Fax Number:
910-844-1035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 N PATTERSON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAXTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-844-1001
Provider Business Practice Location Address Fax Number:
910-844-1035
Provider Enumeration Date:
01/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKLEAR
Authorized Official First Name:
VELISSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANGER
Authorized Official Telephone Number:
910-844-1001

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000969504A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7703309 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE1865 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 045MM . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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