Provider Demographics
NPI:1376113068
Name:ST JUDE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ST JUDE MEDICAL SUPPLY
Other - Org Name:ST. JUDE MEDICAL SUPPLY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-618-8033
Mailing Address - Street 1:3900 MERTON DR STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6636
Mailing Address - Country:US
Mailing Address - Phone:984-242-4742
Mailing Address - Fax:
Practice Address - Street 1:3900 MERTON DR STE 130
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6636
Practice Address - Country:US
Practice Address - Phone:984-242-4742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition