Provider Demographics
NPI:1790837847
Name:TRU-IMAGE MEDICAL
Entity Type:Organization
Organization Name:TRU-IMAGE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-625-1387
Mailing Address - Street 1:1436 EAST DIXIE DRIVE
Mailing Address - Street 2:A
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-7955
Mailing Address - Country:US
Mailing Address - Phone:336-625-1387
Mailing Address - Fax:336-625-1951
Practice Address - Street 1:1436 EAST DIXIE DRIVE
Practice Address - Street 2:A
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-7955
Practice Address - Country:US
Practice Address - Phone:336-625-1387
Practice Address - Fax:336-625-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01247332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5854610001Medicare NSC