Provider Demographics
NPI:1326248550
Name:STALLS MEDICAL, INC.
Entity Type:Organization
Organization Name:STALLS MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:STALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-233-0732
Mailing Address - Street 1:3604 MARINE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8308
Mailing Address - Country:US
Mailing Address - Phone:252-758-8892
Mailing Address - Fax:252-758-5575
Practice Address - Street 1:3604 MARINE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8308
Practice Address - Country:US
Practice Address - Phone:252-758-8892
Practice Address - Fax:252-758-5575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STALLS MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00324332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700468Medicaid
NC0141640003Medicare NSC