Healthcare Provider Details

I. General information

NPI: 1821432295
Provider Name (Legal Business Name): SENIORS MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W CRESCENT SQUARE DR
GRAHAM NC
27253-4014
US

IV. Provider business mailing address

540 W ELM ST
GRAHAM NC
27253-2158
US

V. Phone/Fax

Practice location:
  • Phone: 336-227-0730
  • Fax: 336-227-0732
Mailing address:
  • Phone: 336-227-0730
  • Fax: 336-227-0732

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: DR. VANESSA COBLE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 336-227-0730