Provider Demographics
NPI:1518966456
Name:HUFFMAN MEDICAL, INC.
Entity Type:Organization
Organization Name:HUFFMAN MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-627-0750
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289-1207
Mailing Address - Country:US
Mailing Address - Phone:336-627-0750
Mailing Address - Fax:336-623-7160
Practice Address - Street 1:2260 HARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-7550
Practice Address - Country:US
Practice Address - Phone:336-627-0750
Practice Address - Fax:336-623-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00125332B00000X, 332BP3500X, 332BX2000X
VA0206009062332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701272Medicaid
VA9106472Medicaid
0474WOtherBCBS PROVIDER NUMBER
NC7701272Medicaid