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General NPI Number Information
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NPI Number | 1528116530
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Entity Type | Organization
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Legal Business Name | SUMMERS AND KOONCE INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 214 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3414
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Country | US
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Telephone | 910-484-3161
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Fax | 910-485-6296
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Provider Business Mailing Address
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Address Line | 214 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3414
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Country | US
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Telephone | 910-484-3161
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Fax | 910-485-6296
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Authorized Official
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Title or Position | OWNER
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Name | LARRY KOONCE
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Credential | CERTIFIED PEDOTHIST
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Telephone | 910-484-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 332BC3200X
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License Number State | NC
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