Provider Demographics
NPI:1801185590
Name:HEADGEAR MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:HEADGEAR MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-753-0555
Mailing Address - Street 1:58 COURT SQ
Mailing Address - Street 2:STE 1
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2467
Mailing Address - Country:US
Mailing Address - Phone:336-753-0555
Mailing Address - Fax:
Practice Address - Street 1:58 COURT SQ
Practice Address - Street 2:STE 1
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2467
Practice Address - Country:US
Practice Address - Phone:336-753-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703760Medicaid
NC01781OtherNORTH CAROLINA BOARD OF PHARMACY
S1541OtherTHE BOARD OF CERTIFICATION / ACCREDITATION, INTERNATIONAL
NC7703760Medicaid