Healthcare Provider Details

I. General information

NPI: 1154008894
Provider Name (Legal Business Name): ATTENTIVE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12925 HIGHWAY 601 STE 100
MIDLAND NC
28107-9536
US

IV. Provider business mailing address

11760 GLENWOOD DR
LOCUST NC
28097-7707
US

V. Phone/Fax

Practice location:
  • Phone: 205-218-1906
  • Fax:
Mailing address:
  • Phone: 205-218-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHAMMARA GARDENIA HASTY
Title or Position: CEO
Credential:
Phone: 205-218-1906