Basic Information
| Provider Information | |||||||||
| NPI: | 1073779518 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDOX HEALTHCARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 438 RALEIGH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284126367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107963033 | ||||||||
| FaxNumber: | 9107968841 | ||||||||
| Practice Location | |||||||||
| Address1: | 556 ARBOR HILL RD STE E | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272843321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369934700 | ||||||||
| FaxNumber: | 3369936900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 01/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9107963033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 7705071 | 05 | NC | MEDICAID |