Healthcare Provider Details

I. General information

NPI: 1598740102
Provider Name (Legal Business Name): DAVIE MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 SALISBURY RD
MOCKSVILLE NC
27028-9301
US

IV. Provider business mailing address

959 SALISBURY RD
MOCKSVILLE NC
27028-9301
US

V. Phone/Fax

Practice location:
  • Phone: 336-751-4288
  • Fax:
Mailing address:
  • Phone: 336-751-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHC1590
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHC1590
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHC1590
License Number StateNC

VIII. Authorized Official

Name: MR. GERALD THOMAS MCMILLAN
Title or Position: PRESIDENT/OWNER
Credential: RRT,RCP
Phone: 336-751-4288