Provider Demographics
NPI:1821432295
Name:SENIORS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SENIORS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-227-0730
Mailing Address - Street 1:540 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-2158
Mailing Address - Country:US
Mailing Address - Phone:336-227-0730
Mailing Address - Fax:336-227-0732
Practice Address - Street 1:124 W CRESCENT SQUARE DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-4014
Practice Address - Country:US
Practice Address - Phone:336-227-0730
Practice Address - Fax:336-227-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010186889Medicaid
NC7795360Medicaid
NC7704282Medicaid
SCDE2653Medicaid