Healthcare Provider Details

I. General information

NPI: 1265502439
Provider Name (Legal Business Name): NATIONAL MED SOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 WEST MEMORIAL HWY
UNION GROVE NC
28689-9049
US

IV. Provider business mailing address

PO BOX 103
UNION GROVE NC
28689-0103
US

V. Phone/Fax

Practice location:
  • Phone: 704-539-4445
  • Fax:
Mailing address:
  • Phone: 704-539-4445
  • Fax:

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: MRS. ETHEL R BRADSHAW
Title or Position: SEC
Credential:
Phone: 704-539-4445