Provider Demographics
NPI:1386849271
Name:PACIFIC MEDICAL EQUIPMENT SUPPLY INC
Entity Type:Organization
Organization Name:PACIFIC MEDICAL EQUIPMENT SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:NWAKAMMA
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-881-8210
Mailing Address - Street 1:100 E SIX FORKS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7752
Mailing Address - Country:US
Mailing Address - Phone:919-881-8210
Mailing Address - Fax:919-832-1324
Practice Address - Street 1:100 E SIX FORKS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7752
Practice Address - Country:US
Practice Address - Phone:919-881-8210
Practice Address - Fax:919-832-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC01318332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5969550002Medicare NSC