Provider Demographics
NPI:1346382561
Name:THE MEDICAL WAREHOUSE & SERVICE CENTER, LLC
Entity Type:Organization
Organization Name:THE MEDICAL WAREHOUSE & SERVICE CENTER, LLC
Other - Org Name:USED MEDICAL WAREHOUSE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-803-2516
Mailing Address - Street 1:657 GRALIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3457
Mailing Address - Country:US
Mailing Address - Phone:336-803-2516
Mailing Address - Fax:336-996-3178
Practice Address - Street 1:657 GRALIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3457
Practice Address - Country:US
Practice Address - Phone:336-803-2516
Practice Address - Fax:336-996-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00493332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703507Medicaid
NC4279040001Medicare ID - Type Unspecified