Provider Demographics
NPI:1124411343
Name:PARAMOUNT MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:PARAMOUNT MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:GLASCO
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-561-3329
Mailing Address - Street 1:6012 OLD PINEVILLE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3604
Mailing Address - Country:US
Mailing Address - Phone:704-561-3329
Mailing Address - Fax:
Practice Address - Street 1:6012 OLD PINEVILLE RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3604
Practice Address - Country:US
Practice Address - Phone:704-561-3329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAMOUNT MEDICAL SUPPLY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies