Provider Demographics
NPI:1578512158
Name:ATLAS MEDICAL SUPPLY AND EQUIPMENT
Entity Type:Organization
Organization Name:ATLAS MEDICAL SUPPLY AND EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:1
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-375-3966
Mailing Address - Street 1:2315 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5207
Mailing Address - Country:US
Mailing Address - Phone:704-375-3966
Mailing Address - Fax:704-375-3964
Practice Address - Street 1:2315 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5207
Practice Address - Country:US
Practice Address - Phone:704-375-3966
Practice Address - Fax:704-375-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNONE283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC705083OtherIPA
SCDE2455Medicaid
NC7704191Medicaid
NC5182470001Medicare ID - Type Unspecified