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General NPI Number Information
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NPI Number | 1134106578
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Entity Type | Organization
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Legal Business Name | KANAWHA MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 7009 FOREST HILL AVE
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City | RICHMOND
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State | VA
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Zip | 23225-1607
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Country | US
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Telephone | 804-330-5937
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Fax | 804-330-7149
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Provider Business Mailing Address
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Address Line | 7009 FOREST HILL AVE
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City | RICHMOND
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State | VA
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Zip | 23225-1607
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Country | US
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Telephone | 804-330-5743
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Fax | 804-330-7149
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT
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Name | MRS. DYANE B PERGERSON
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Credential |
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Telephone | 434-352-7671
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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 |
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License Number State |
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