Provider Demographics
NPI:1154354165
Name:ASSURED HOME RESPIRATORY & MEDICAL EQUIPMENT INC.
Entity type:Organization
Organization Name:ASSURED HOME RESPIRATORY & MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACGILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-442-8830
Mailing Address - Street 1:3711 LATROBE DR
Mailing Address - Street 2:STE. 550
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1164
Mailing Address - Country:US
Mailing Address - Phone:704-442-8830
Mailing Address - Fax:
Practice Address - Street 1:3711 LATROBE DR
Practice Address - Street 2:STE. 550
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1164
Practice Address - Country:US
Practice Address - Phone:704-442-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00934332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5354540001Medicare NSC