MEDICARE: FOOD LION LLC

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	09111	NC
2	332BC3200X	Customized Equipment (DME)
3	3336C0003X	Community/Retail Pharmacy	09111	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3403603	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1144313511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD LION LLC

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:	MAILSORT 3000
City	:	PORTLAND
State	:	ME
Zip	:	04104-5005
Country	:	US
Telephone Number	:	207-885-7454
Fax Number	:	207-885-3121

Provider Business Practice Location Address
First Line	:	1460 S MAIN ST
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-8646
Country	:	US
Telephone Number	:	704-855-1316
Fax Number	:	704-857-5028

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARGARET M HAM
Credential	:
Telephone Number	:	207-885-7454

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	05/11/2017

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Directions to “FOOD LION LLC ” Practice Location

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