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NPI Code Detail

MEDICARE: PRODIGY HEALTHCARE SERVICES INC.

MEDICARE: PRODIGY HEALTHCARE SERVICES 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
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699722272
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRODIGY HEALTHCARE SERVICES INC.
Provider Business Mailing Address
First Line : 4801 HARGROVE ROAD
Second Line : SUITE 12
City : RALEIGH
State : NC
Zip : 27616-1949
Country : US
Telephone Number : 919-264-9769
Fax Number : 919-341-5838
Provider Business Practice Location Address
First Line : 4801 HARGROVE ROAD
Second Line : SUITE 12
City : RALEIGH
State : NC
Zip : 27616-1949
Country : US
Telephone Number : 919-264-9769
Fax Number : 919-341-5838
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. KELECHI C UWAKWE
Credential : R.N.
Telephone Number : 919-264-9769
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/01/2009

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Directions to “PRODIGY HEALTHCARE SERVICES INC. ” Practice Location

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