Provider Demographics
NPI:1942473723
Name:MEDIK CAROLINA MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:MEDIK CAROLINA MEDICAL SUPPLIES, INC.
Other - Org Name:DEVOTED HANDS HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAFAYETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-790-3302
Mailing Address - Street 1:5736 N TRYON ST
Mailing Address - Street 2:SUITE 223B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6850
Mailing Address - Country:US
Mailing Address - Phone:704-790-3302
Mailing Address - Fax:
Practice Address - Street 1:5736 N TRYON ST
Practice Address - Street 2:SUITE 223B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6850
Practice Address - Country:US
Practice Address - Phone:704-790-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies