Provider Demographics
NPI:1003034471
Name:MEDIDON
Entity Type:Organization
Organization Name:MEDIDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:877-348-2727
Mailing Address - Street 1:213 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2427
Mailing Address - Country:US
Mailing Address - Phone:877-348-2727
Mailing Address - Fax:919-869-1934
Practice Address - Street 1:213 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2427
Practice Address - Country:US
Practice Address - Phone:877-348-2727
Practice Address - Fax:919-869-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07-00019270332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies