Basic Information
| Provider Information | |||||||||
| NPI: | 1073569679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOVELL MEDICAL SUPPLY INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AEROCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3325 BARTLETT BLVD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328116428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072060040 | ||||||||
| FaxNumber: | 4072060010 | ||||||||
| Practice Location | |||||||||
| Address1: | 186 WEST INDEPENDENCE BLVD | ||||||||
| Address2: | |||||||||
| City: | MT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367861410 | ||||||||
| FaxNumber: | 3367861472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | GRIGGS | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4072060040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AEROCARE HOLDINGS INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 01525 | NC | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1073569679 | 05 | VA | MEDICAID | 0421U | 01 | NC | BCBS | OTHER | 34015 | 01 | PARTNERS | OTHER | 7704677 | 05 | NC | MEDICAID |