Healthcare Provider Details

I. General information

NPI: 1467904292
Provider Name (Legal Business Name): RECHANNEL EXPRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 WINDEL DR
RALEIGH NC
27609-4442
US

IV. Provider business mailing address

214 WINDEL DR
RALEIGH NC
27609-4442
US

V. Phone/Fax

Practice location:
  • Phone: 919-906-3439
  • Fax:
Mailing address:
  • Phone: 919-906-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULL FLANAGAN
Title or Position: OWER
Credential: MD
Phone: 919-906-3436