Provider Demographics
NPI:1548594948
Name:SALEM MOBILITY AND MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SALEM MOBILITY AND MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-978-2770
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-0449
Mailing Address - Country:US
Mailing Address - Phone:336-766-4480
Mailing Address - Fax:336-766-4498
Practice Address - Street 1:2565A OLD GLORY RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9276
Practice Address - Country:US
Practice Address - Phone:336-766-4480
Practice Address - Fax:336-766-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705192Medicaid
NC7705192Medicaid