Provider Demographics
NPI:1699341750
Name:M-A-D MEDICAL SUPPLIES & EQUIPMENT
Entity type:Organization
Organization Name:M-A-D MEDICAL SUPPLIES & EQUIPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAMEIKA
Authorized Official - Middle Name:SIMONE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-810-8844
Mailing Address - Street 1:104 LISAS WAY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9625
Mailing Address - Country:US
Mailing Address - Phone:984-810-8844
Mailing Address - Fax:
Practice Address - Street 1:104 LISAS WAY
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9625
Practice Address - Country:US
Practice Address - Phone:252-207-6695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies