Provider Demographics
NPI:1598087660
Name:UNIVERSAL DISTRIBUTORS
Entity Type:Organization
Organization Name:UNIVERSAL DISTRIBUTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-723-9662
Mailing Address - Street 1:1101 TYVOLA RD
Mailing Address - Street 2:SUITE 321
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3515
Mailing Address - Country:US
Mailing Address - Phone:704-277-3135
Mailing Address - Fax:800-851-3009
Practice Address - Street 1:1101 TYVOLA RD
Practice Address - Street 2:SUITE 321
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:704-277-3135
Practice Address - Fax:800-851-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies