Provider Demographics
NPI:1962696724
Name:STATES MEDICAL PRODUCTS, LLC
Entity type:Organization
Organization Name:STATES MEDICAL PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NNENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-603-6904
Mailing Address - Street 1:911 LINDEN AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3652
Mailing Address - Country:US
Mailing Address - Phone:919-603-6904
Mailing Address - Fax:919-603-6905
Practice Address - Street 1:911 LINDEN AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3652
Practice Address - Country:US
Practice Address - Phone:919-603-6904
Practice Address - Fax:919-603-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01335332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01335OtherNC BOARD OF PHARMACY
6017730001Medicare NSC