Provider Demographics
NPI:1649239724
Name:UNITED MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:UNITED MEDICAL SUPPLIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRT CPED
Authorized Official - Phone:252-348-4000
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851
Mailing Address - Country:US
Mailing Address - Phone:757-516-2530
Mailing Address - Fax:757-516-2531
Practice Address - Street 1:201 W FOURTH AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851
Practice Address - Country:US
Practice Address - Phone:757-516-2530
Practice Address - Fax:757-516-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01109332B00000X
VA0206009302332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704379Medicaid
VA58391OtherCARE NET PLAN SERVICES
NC7704379Medicaid