Provider Demographics
NPI:1467650440
Name:CAROLINA MEDICAL SPECIALTIES, INC.
Entity Type:Organization
Organization Name:CAROLINA MEDICAL SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SLEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-977-5511
Mailing Address - Street 1:PO BOX 53277
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-3277
Mailing Address - Country:US
Mailing Address - Phone:910-485-0500
Mailing Address - Fax:910-485-2600
Practice Address - Street 1:420 RALEIGH ST
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6316
Practice Address - Country:US
Practice Address - Phone:910-452-0999
Practice Address - Fax:910-452-2935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA MEDICAL SPECIALTIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01163332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01163OtherBOARD OF PHARMACY PERMIT