Provider Demographics
NPI:1831535806
Name:CITY MEDICAL SUPPLY
Entity type:Organization
Organization Name:CITY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:CHIBUZO
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEBOLISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-327-2914
Mailing Address - Street 1:8025 N POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3262
Mailing Address - Country:US
Mailing Address - Phone:336-327-2914
Mailing Address - Fax:
Practice Address - Street 1:8025 N POINT BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3262
Practice Address - Country:US
Practice Address - Phone:336-327-2914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies