Provider Demographics
NPI:1508336058
Name:DOVE MEDICAL SUPPLY RETAIL LLC
Entity Type:Organization
Organization Name:DOVE MEDICAL SUPPLY RETAIL LLC
Other - Org Name:DOVE MEDICAL SUPPLY RETAIL LLC - WINSTON
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-643-9367
Mailing Address - Street 1:8164 MABE MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9225
Mailing Address - Country:US
Mailing Address - Phone:336-643-9367
Mailing Address - Fax:336-419-0160
Practice Address - Street 1:676 HANES MALL BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5670
Practice Address - Country:US
Practice Address - Phone:336-842-5108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies