Healthcare Provider Details

I. General information

NPI: 1740430933
Provider Name (Legal Business Name): UNITED ASSIST MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 LEE AVE SUITE 3
SANFORD NC
27330-5756
US

IV. Provider business mailing address

1819 LEE AVE SUITE 3
SANFORD NC
27330-5756
US

V. Phone/Fax

Practice location:
  • Phone: 919-776-1144
  • Fax: 919-776-1147
Mailing address:
  • Phone: 919-776-1144
  • Fax: 919-776-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number01462
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number01462
License Number StateNC

VIII. Authorized Official

Name: MR. CHARLES ASSAOTCHI
Title or Position: CEO
Credential:
Phone: 919-776-1144