Provider Demographics
NPI:1245210186
Name:MED-SOUTH MEDICAL INC.
Entity Type:Organization
Organization Name:MED-SOUTH MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-554-0103
Mailing Address - Street 1:12705 SANDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5308
Mailing Address - Country:US
Mailing Address - Phone:919-870-1251
Mailing Address - Fax:919-554-0217
Practice Address - Street 1:934C DURHAM RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9033
Practice Address - Country:US
Practice Address - Phone:919-554-0103
Practice Address - Fax:919-554-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
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
NC5081810001Medicare NSC