Provider Demographics
NPI:1235276452
Name:INDEPENDENT MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERWOOD
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:ENZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-654-4876
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-0353
Mailing Address - Country:US
Mailing Address - Phone:910-654-4876
Mailing Address - Fax:910-654-6876
Practice Address - Street 1:633 N BROWN ST
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1305
Practice Address - Country:US
Practice Address - Phone:910-654-4876
Practice Address - Fax:910-654-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704006Medicaid
NC5041760001Medicare ID - Type Unspecified