MEDICARE: MEDICAL SUPPLIES ETC 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
2	332BC3200X	Customized Equipment (DME)		NC
3	332BD1200X	Dialysis Equipment & Supplies (DME)		NC
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)		NC
5	335E00000X	Prosthetic/Orthotic Supplier	C51438	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000000	OTHER	NC	BILLING SERVICE

General Provider Information

NPI Number	:	1295280139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SUPPLIES ETC INC

Provider Business Mailing Address
First Line	:	306 PENNY LN
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4306
Country	:	US
Telephone Number	:	252-732-0215
Fax Number	:	252-565-1733

Provider Business Practice Location Address
First Line	:	306 PENNY LN
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4306
Country	:	US
Telephone Number	:	252-732-0215
Fax Number	:	252-565-1733

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. SHARON MEEKS
Credential	:
Telephone Number	:	252-732-0215

Provider Enumeration Date	:	08/21/2016
Last Update Date	:	08/21/2016

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