Provider Demographics
NPI:1891397576
Name:DOVE MEDICAL SUPPLY RETAIL LLC
Entity Type:Organization
Organization Name:DOVE MEDICAL SUPPLY RETAIL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-508-2016
Mailing Address - Street 1:155 S EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166-9609
Mailing Address - Country:US
Mailing Address - Phone:704-508-2016
Mailing Address - Fax:
Practice Address - Street 1:7301 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9150
Practice Address - Country:US
Practice Address - Phone:336-441-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOVE MEDICAL SUPPLY RETAIL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-09
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies