Provider Demographics
NPI:1598740102
Name:DAVIE MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:DAVIE MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,RCP
Authorized Official - Phone:336-751-4288
Mailing Address - Street 1:959 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-9301
Mailing Address - Country:US
Mailing Address - Phone:336-751-4288
Mailing Address - Fax:
Practice Address - Street 1:959 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-9301
Practice Address - Country:US
Practice Address - Phone:336-751-4288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1590332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13742OtherPARTNERS
NC0421LOtherBCBS
NC36198OtherWELLPATH
NC7701586Medicaid
NC13742OtherPARTNERS
NC1027550001Medicare NSC