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General NPI Number Information
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NPI Number | 1699776088
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Entity Type | Organization
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Legal Business Name | KOVINE MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 620 S ELM ST STE 374
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City | GREENSBORO
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State | NC
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Zip | 27406-1398
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Country | US
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Telephone | 336-398-9343
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Fax | 336-389-9334
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Provider Business Mailing Address
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Address Line | 620 S ELM ST STE 374
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City | GREENSBORO
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State | NC
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Zip | 27406-1398
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Country | US
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Telephone | 336-398-9343
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Fax | 336-389-9334
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Authorized Official
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Title or Position | OWNER
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Name | MR. KPOTO OKON ISANGEDIGHI
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Credential |
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Telephone | 336-389-9343
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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 | 600442227
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License Number State | NC
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