Provider Demographics
NPI:1063160687
Name:SCOG HOME MEDICAL SUPPLY
Entity type:Organization
Organization Name:SCOG HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OZENIM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:IGUMBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-557-9921
Mailing Address - Street 1:16139 STUARTS DRAFT CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7278
Mailing Address - Country:US
Mailing Address - Phone:770-557-9921
Mailing Address - Fax:
Practice Address - Street 1:9635 SOUTHERN PINE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5545
Practice Address - Country:US
Practice Address - Phone:980-224-9000
Practice Address - Fax:980-224-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier