Healthcare Provider Details

I. General information

NPI: 1952238230
Provider Name (Legal Business Name): DOVE MEDICAL SUPPLY RETAIL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S EASTWAY DR
TROUTMAN NC
28166-9609
US

IV. Provider business mailing address

8164 MABE MARSHALL RD BLDG 2
SUMMERFIELD NC
27358-9225
US

V. Phone/Fax

Practice location:
  • Phone: 704-508-1418
  • Fax: 336-419-0160
Mailing address:
  • Phone: 336-643-9367
  • Fax: 336-419-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TAMMY D BRIDGES
Title or Position: CEO
Credential:
Phone: 336-643-9367