MEDICARE: SENIORS MEDICAL SUPPLY

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 State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	046TK	OTHER	NC	BCBS OF NC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548246804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIORS MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	540 WEST ELM STREET
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-2158
Country	:	US
Telephone Number	:	236-227-0730
Fax Number	:	336-227-0732

Provider Business Practice Location Address
First Line	:	540 W ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-2158
Country	:	US
Telephone Number	:	236-227-0730
Fax Number	:	336-227-0732

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	MS. VANESSA T. COBLE
Credential	:	PHD
Telephone Number	:	336-227-0730

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	01/30/2012

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540 W ELM ST
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1164413373 — MELISSA LYNN KUCERA
Practice Location Address:

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Directions to “SENIORS MEDICAL SUPPLY ” Practice Location

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