MEDICARE: KANAWHA MEDICAL SUPPLY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	231350	OTHER	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134106578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANAWHA MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	7009 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1607
Country	:	US
Telephone Number	:	804-330-5743
Fax Number	:	804-330-7149

Provider Business Practice Location Address
First Line	:	7009 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1607
Country	:	US
Telephone Number	:	804-330-5937
Fax Number	:	804-330-7149

Authorized Official
Title or Position	:	OWNER/VICE PRESIDENT
Name	:	MRS. DYANE B PERGERSON
Credential	:
Telephone Number	:	434-352-7671

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	04/10/2013

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Directions to “KANAWHA MEDICAL SUPPLY INC ” Practice Location

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