Provider Demographics
NPI:1700836806
Name:PENROD MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:PENROD MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER / MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-630-1155
Mailing Address - Street 1:1806 W INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2554
Mailing Address - Country:US
Mailing Address - Phone:704-630-1155
Mailing Address - Fax:888-462-4916
Practice Address - Street 1:1806 W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2554
Practice Address - Country:US
Practice Address - Phone:704-630-1155
Practice Address - Fax:888-462-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00829332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703906Medicaid
NCV21893OtherVGM GROUP COMPANY
NC5473810001Medicare ID - Type Unspecified