Provider Demographics
NPI:1346323938
Name:POWELL MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:POWELL MEDICAL EQUIPMENT LLC
Other - Org Name:POWELL MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:VI
Authorized Official - Credentials:ATP
Authorized Official - Phone:919-615-1531
Mailing Address - Street 1:550 PYLON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1415
Mailing Address - Country:US
Mailing Address - Phone:919-615-1531
Mailing Address - Fax:919-615-1624
Practice Address - Street 1:550 PYLON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1415
Practice Address - Country:US
Practice Address - Phone:919-615-1531
Practice Address - Fax:919-615-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045PHOtherBCBS PROVIDER NUMBER
NC7703276Medicaid
NC7703276Medicaid