Provider Demographics
NPI:1982689105
Name:RUBY S BESHEARS
Entity Type:Organization
Organization Name:RUBY S BESHEARS
Other - Org Name:PENNYRICH BRAS & LINGERIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BESHEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-784-0803
Mailing Address - Street 1:3030 GREENHOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7206
Mailing Address - Country:US
Mailing Address - Phone:336-784-0803
Mailing Address - Fax:
Practice Address - Street 1:3030 GREENHOUSE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7206
Practice Address - Country:US
Practice Address - Phone:336-784-0803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0437QOtherBCBS
NC7701749Medicaid
NC0437QOtherBCBS
NC0250980001Medicare Oscar/Certification
NC0250980001Medicare NSC