Provider Demographics
NPI:1740430933
Name:UNITED ASSIST MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:UNITED ASSIST MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSAOTCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-776-1144
Mailing Address - Street 1:1819 LEE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5756
Mailing Address - Country:US
Mailing Address - Phone:919-776-1144
Mailing Address - Fax:919-776-1147
Practice Address - Street 1:1819 LEE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5756
Practice Address - Country:US
Practice Address - Phone:919-776-1144
Practice Address - Fax:919-776-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01462332BC3200X, 332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705232Medicaid
NC7705232Medicaid