Provider Demographics
NPI:1164415378
Name:PRO MED EQUIPMENT AND SUPPLY INC
Entity Type:Organization
Organization Name:PRO MED EQUIPMENT AND SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERVICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAMBLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-332-8081
Mailing Address - Street 1:601 MEMORIAL DR E
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3935
Mailing Address - Country:US
Mailing Address - Phone:252-332-8081
Mailing Address - Fax:252-332-8091
Practice Address - Street 1:601 MEMORIAL DR E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3935
Practice Address - Country:US
Practice Address - Phone:252-332-8081
Practice Address - Fax:252-332-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X, 332BP3500X
NC00609332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703460Medicaid
NC7703460Medicaid