Provider Demographics
NPI:1073976452
Name:PIEDMONT MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:PIEDMONT MEDICAL SUPPLY INC
Other - Org Name:A PERFECT FIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-386-6250
Mailing Address - Street 1:184 BOONE HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4953
Mailing Address - Country:US
Mailing Address - Phone:828-386-6250
Mailing Address - Fax:828-386-6253
Practice Address - Street 1:184 BOONE HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4953
Practice Address - Country:US
Practice Address - Phone:828-386-6250
Practice Address - Fax:828-386-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC18040332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795462Medicaid
NC7700095Medicaid
NC7795462Medicaid
0253530001Medicare PIN