MEDICARE: TARHEEL MEDICAL SUPPLY LLC

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	:	1992924120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARHEEL MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	1201 RALEIGH RD
Second Line	:	SUITE C
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-4047
Country	:	US
Telephone Number	:	919-969-2669
Fax Number	:	919-969-2644

Provider Business Practice Location Address
First Line	:	1201 RALEIGH RD STE C
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-4047
Country	:	US
Telephone Number	:	919-969-2669
Fax Number	:	919-969-2644

Authorized Official
Title or Position	:	OWNER AND CEO
Name	:	PHILLIP EUGENE DAVIS SR.
Credential	:	PH.D.
Telephone Number	:	919-969-2669

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	03/14/2008

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