Healthcare Provider Details

I. General information

NPI: 1265830335
Provider Name (Legal Business Name): A PERFECT FIT FOR YOU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 ARENDELL ST SUITE 6
MOREHEAD CITY NC
28557-3318
US

IV. Provider business mailing address

2900 ARENDELL ST SUITE 6
MOREHEAD CITY NC
28557-3318
US

V. Phone/Fax

Practice location:
  • Phone: 252-622-4506
  • Fax: 252-622-4512
Mailing address:
  • Phone: 252-622-4506
  • Fax: 252-622-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberS28948
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License NumberS28948
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberS28948
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberS28948
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7289360001
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerPALMETTO GBA
# 2
Identifier1265830335
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MRS. MARGARET GIBSON
Title or Position: PRESIDENT
Credential:
Phone: 252-622-4506