Provider Demographics
NPI:1568743995
Name:XCALIBUR SPORTS CHAIRS, LLC
Entity Type:Organization
Organization Name:XCALIBUR SPORTS CHAIRS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-210-2686
Mailing Address - Street 1:55 PEARL INDUSTRIAL AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-4407
Mailing Address - Country:US
Mailing Address - Phone:800-210-2686
Mailing Address - Fax:678-500-9543
Practice Address - Street 1:55 PEARL INDUSTRIAL AVE
Practice Address - Street 2:STE 200
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-4407
Practice Address - Country:US
Practice Address - Phone:800-210-2686
Practice Address - Fax:678-500-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies