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General NPI Number Information
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NPI Number | 1154008894
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Entity Type | Organization
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Legal Business Name | ATTENTIVE MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 07/04/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 12925 HIGHWAY 601 STE 100
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City | MIDLAND
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State | NC
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Zip | 28107-9536
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Country | US
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Telephone | 205-218-1906
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Fax |
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Provider Business Mailing Address
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Address Line | 11760 GLENWOOD DR
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City | LOCUST
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State | NC
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Zip | 28097-7707
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Country | US
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Telephone | 205-218-1906
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHAMMARA GARDENIA HASTY
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Credential |
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Telephone | 205-218-1906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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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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