Provider Demographics
NPI:1477719136
Name:MED-SUPPLY
Entity Type:Organization
Organization Name:MED-SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-935-7997
Mailing Address - Street 1:PO BOX 2694
Mailing Address - Street 2:1018 JA YATES ST
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-2694
Mailing Address - Country:US
Mailing Address - Phone:276-935-7997
Mailing Address - Fax:276-935-7997
Practice Address - Street 1:1018 JA YATES ST
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-6154
Practice Address - Country:US
Practice Address - Phone:276-935-7997
Practice Address - Fax:276-935-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies