Provider Demographics
NPI:1720085079
Name:UNITED MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:UNITED MEDICAL SUPPLIES INC
Other - Org Name:UNITED MEDICAL HOME OXYGEN AND MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
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:RT
Authorized Official - Phone:252-348-4000
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NC
Mailing Address - Zip Code:27849-0098
Mailing Address - Country:US
Mailing Address - Phone:252-348-4000
Mailing Address - Fax:252-348-4001
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NC
Practice Address - Zip Code:27849-9690
Practice Address - Country:US
Practice Address - Phone:252-348-4000
Practice Address - Fax:252-348-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00512332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703192Medicaid
NC1323210001Medicare ID - Type Unspecified