Healthcare Provider Details

I. General information

NPI: 1467650440
Provider Name (Legal Business Name): CAROLINA MEDICAL SPECIALTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 RALEIGH ST SUITE D
WILMINGTON NC
28412-6316
US

IV. Provider business mailing address

PO BOX 53277
FAYETTEVILLE NC
28305-3277
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-0999
  • Fax: 910-452-2935
Mailing address:
  • Phone: 910-485-0500
  • Fax: 910-485-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01163
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number01163
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number01163
License Number StateNC

VIII. Authorized Official

Name: MR. DIMITRI K. SLEEM
Title or Position: DIRECTOR
Credential:
Phone: 910-977-5511