MEDICARE: SALEM MOBILITY AND MEDICAL SUPPLY 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

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	:	1548594948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM MOBILITY AND MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-0449
Country	:	US
Telephone Number	:	336-766-4480
Fax Number	:	336-766-4498

Provider Business Practice Location Address
First Line	:	2565A OLD GLORY RD
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9276
Country	:	US
Telephone Number	:	336-766-4480
Fax Number	:	336-766-4498

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONNIE L TOWNSEND JR.
Credential	:
Telephone Number	:	336-978-2770

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	01/19/2011

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