Healthcare Provider Details

I. General information

NPI: 1679163711
Provider Name (Legal Business Name): DOVE MEDICAL SUPPLY RETAIL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 BATTLEGROUND AVE STE D
GREENSBORO NC
27410-2362
US

IV. Provider business mailing address

155 S EASTWAY DR
TROUTMAN NC
28166-9609
US

V. Phone/Fax

Practice location:
  • Phone: 336-285-7849
  • Fax: 336-419-0160
Mailing address:
  • Phone: 704-508-2016
  • Fax: 336-419-0160

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: REBEKAH ANN CAMILLE SPEASE
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 336-448-0086