Provider Demographics
NPI:1679672935
Name:NORTH CAROLINE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:NORTH CAROLINE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-226-2130
Mailing Address - Street 1:1550 MADRUGA AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3039
Mailing Address - Country:US
Mailing Address - Phone:305-226-2130
Mailing Address - Fax:
Practice Address - Street 1:1550 MADRUGA AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3039
Practice Address - Country:US
Practice Address - Phone:305-226-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies