Provider Demographics
NPI:1073823381
Name:NICK'S DISCOUNT MEDICAL, LLC
Entity Type:Organization
Organization Name:NICK'S DISCOUNT MEDICAL, LLC
Other - Org Name:NICK'S DISCOUNT MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ VP
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-323-8271
Mailing Address - Street 1:201 N PINETTA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4915
Mailing Address - Country:US
Mailing Address - Phone:804-323-8271
Mailing Address - Fax:804-323-9022
Practice Address - Street 1:201 N PINETTA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4915
Practice Address - Country:US
Practice Address - Phone:804-323-8271
Practice Address - Fax:804-323-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1199047332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies