Provider Demographics
NPI:1477536449
Name:HELEN GORDON
Entity Type:Organization
Organization Name:HELEN GORDON
Other - Org Name:CAMEO BRA SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICARE PROVIDER DM
Authorized Official - Phone:336-788-3052
Mailing Address - Street 1:3578 HEATHROW DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-4674
Mailing Address - Country:US
Mailing Address - Phone:336-788-3052
Mailing Address - Fax:
Practice Address - Street 1:3578 HEATHROW DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-4674
Practice Address - Country:US
Practice Address - Phone:336-788-3052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0474COtherBCBS NC
NC2404OtherPARTNERS
NC7701509Medicaid
0519850001Medicare NSC