Provider Demographics
NPI:1700329307
Name:MEDWORX HOME MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:MEDWORX HOME MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-665-4094
Mailing Address - Street 1:109 HINTON AVE
Mailing Address - Street 2:UNIT 13
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4786
Mailing Address - Country:US
Mailing Address - Phone:864-547-2200
Mailing Address - Fax:864-547-2201
Practice Address - Street 1:109 HINTON AVE
Practice Address - Street 2:UNIT 13
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4786
Practice Address - Country:US
Practice Address - Phone:864-547-2200
Practice Address - Fax:864-547-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies