Provider Demographics
NPI:1255198230
Name:SPIC MEDICAL EQUIPMENT SUPPLY
Entity type:Organization
Organization Name:SPIC MEDICAL EQUIPMENT SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PERSON-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUZULIKE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MR
Authorized Official - Phone:919-395-5262
Mailing Address - Street 1:140 MINE LAKE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6417
Mailing Address - Country:US
Mailing Address - Phone:919-395-5262
Mailing Address - Fax:919-518-8295
Practice Address - Street 1:140 MINE LAKE CT STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6417
Practice Address - Country:US
Practice Address - Phone:919-395-5262
Practice Address - Fax:919-518-8295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERENITY PLACE INTERVENTION CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-05
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03163OtherDME PERMIT