Healthcare Provider Details

I. General information

NPI: 1629078886
Provider Name (Legal Business Name): THUTT ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704-K PLAZA BLVD
KINSTON NC
28501-1567
US

IV. Provider business mailing address

704-K PLAZA BLVD
KINSTON NC
28501-1567
US

V. Phone/Fax

Practice location:
  • Phone: 252-527-2106
  • Fax: 252-527-1217
Mailing address:
  • Phone: 252-527-2106
  • Fax: 252-527-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number04490
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number04490
License Number StateNC

VIII. Authorized Official

Name: THOMAS R. THUTT
Title or Position: PRESIDENT
Credential: RPH
Phone: 252-527-2106