MEDICARE: PERRY MEDICAL RESOURCES 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	00402	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

General Provider Information

NPI Number	:	1184831711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY MEDICAL RESOURCES LLC

Provider Business Mailing Address
First Line	:	1533 HERITAGE GARDEN ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4360
Country	:	US
Telephone Number	:	919-468-5859
Fax Number	:	919-468-5022

Provider Business Practice Location Address
First Line	:	1533 HERITAGE GARDEN ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4360
Country	:	US
Telephone Number	:	919-468-5859
Fax Number	:	919-468-5022

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD HENRY PERRY
Credential	:
Telephone Number	:	919-468-5859

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	04/14/2008

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