Provider Demographics
NPI:1164525176
Name:SALEM MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SALEM MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OKECHUKWU
Authorized Official - Last Name:UBABUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-896-0503
Mailing Address - Street 1:4265 BROWNSBORO RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-896-0503
Mailing Address - Fax:336-896-0603
Practice Address - Street 1:4265 BROWNSBORO RD
Practice Address - Street 2:SUITE 240
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-896-0503
Practice Address - Fax:336-896-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046VJOtherBCBS OF NC
050447050OtherTRICARE
NC7703783Medicaid
806920OtherPARTNERS
NC7703783Medicaid