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General NPI Number Information
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NPI Number | 1073823381
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Entity Type | Organization
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Legal Business Name | NICK'S DISCOUNT MEDICAL, LLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 201 N PINETTA DR
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City | RICHMOND
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State | VA
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Zip | 23235-4915
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Country | US
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Telephone | 804-323-8271
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Fax | 804-323-9022
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Provider Business Mailing Address
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Address Line | 201 N PINETTA DR
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City | RICHMOND
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State | VA
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Zip | 23235-4915
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Country | US
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Telephone | 804-323-8271
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Fax | 804-323-9022
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Authorized Official
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Title or Position | CEO/ VP
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Name | PAUL DAVID LILLY
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Credential |
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Telephone | 804-323-8271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1199047
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License Number State | VA
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