Provider Demographics
NPI:1194784702
Name:UNITED MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:UNITED MEDICAL SUPPLIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRT CPED
Authorized Official - Phone:252-348-4040
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874
Mailing Address - Country:US
Mailing Address - Phone:252-826-4040
Mailing Address - Fax:252-826-4961
Practice Address - Street 1:1120 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874
Practice Address - Country:US
Practice Address - Phone:252-826-4040
Practice Address - Fax:252-826-4961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00813332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045EWOtherBCBS
NC7703911Medicaid
NC1323210002Medicare NSC