MEDICARE: DICKENS HEALTH CARE SUPPLIES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	550	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023077963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICKENS HEALTH CARE SUPPLIES, INC

Provider Business Mailing Address
First Line	:	625 E WASHINGTON ST
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1737
Country	:	US
Telephone Number	:	252-462-0500
Fax Number	:	252-462-0521

Provider Business Practice Location Address
First Line	:	625 E WASHINGTON ST
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1737
Country	:	US
Telephone Number	:	252-462-0500
Fax Number	:	252-462-0521

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DONNA HOOTEN DICKENS
Credential	:	CFM, CFTS
Telephone Number	:	252-462-0500

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/27/2010

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