Provider Demographics
NPI:1891761078
Name:MEDICAL DISTRIBUTORS OF NORTH CAROLINA, INC.
Entity Type:Organization
Organization Name:MEDICAL DISTRIBUTORS OF NORTH CAROLINA, INC.
Other - Org Name:MEDICAL EQUIPEMENT DISTRIBUTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:BRIGHT
Authorized Official - Last Name:LUBBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-873-9168
Mailing Address - Street 1:PO BOX 98643
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-8643
Mailing Address - Country:US
Mailing Address - Phone:919-873-9168
Mailing Address - Fax:919-873-9407
Practice Address - Street 1:2200 E MILLBROOK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1788
Practice Address - Country:US
Practice Address - Phone:919-873-9168
Practice Address - Fax:919-873-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0459ROtherBLUE CROSS
NC7701525Medicaid
NC7701525Medicaid