Provider Demographics
NPI:1023088432
Name:LOCKLEAR MEDICAL SUPPLIES,INC
Entity type:Organization
Organization Name:LOCKLEAR MEDICAL SUPPLIES,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:COFM
Authorized Official - Phone:910-844-1001
Mailing Address - Street 1:114 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1735
Mailing Address - Country:US
Mailing Address - Phone:910-844-1001
Mailing Address - Fax:910-844-1035
Practice Address - Street 1:114 N PATTERSON ST.
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364
Practice Address - Country:US
Practice Address - Phone:910-844-1001
Practice Address - Fax:910-844-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2011-09-29
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
GA000969504AMedicaid
NC7703309Medicaid
SCDE1865Medicaid
NC045MMOtherBCBS
NC045MMOtherBCBS