Provider Demographics
NPI:1699776088
Name:KOVINE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:KOVINE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KPOTO
Authorized Official - Middle Name:OKON
Authorized Official - Last Name:ISANGEDIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-389-9343
Mailing Address - Street 1:620 S ELM ST
Mailing Address - Street 2:STE 374
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1398
Mailing Address - Country:US
Mailing Address - Phone:336-398-9343
Mailing Address - Fax:336-389-9334
Practice Address - Street 1:620 S ELM ST
Practice Address - Street 2:STE 374
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1398
Practice Address - Country:US
Practice Address - Phone:336-398-9343
Practice Address - Fax:336-389-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600442227332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5253080001Medicare NSC