Provider Demographics
NPI:1790284248
Name:SIMPLY MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:SIMPLY MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-474-0290
Mailing Address - Street 1:123 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28128-9603
Mailing Address - Country:US
Mailing Address - Phone:704-474-0290
Mailing Address - Fax:704-474-0295
Practice Address - Street 1:123 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NC
Practice Address - Zip Code:28128-9603
Practice Address - Country:US
Practice Address - Phone:704-474-0290
Practice Address - Fax:704-474-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment