Healthcare Provider Details

I. General information

NPI: 1235276452
Provider Name (Legal Business Name): INDEPENDENT MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N BROWN ST
CHADBOURN NC
28431-1305
US

IV. Provider business mailing address

PO BOX 353
CHADBOURN NC
28431-0353
US

V. Phone/Fax

Practice location:
  • Phone: 910-654-4876
  • Fax: 910-654-6876
Mailing address:
  • Phone: 910-654-4876
  • Fax: 910-654-6876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. SHERWOOD SHANE ENZOR
Title or Position: PRESIDENT MANAGER
Credential:
Phone: 910-654-4876