Provider Demographics
NPI:1992905160
Name:RALEIGH MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:RALEIGH MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LUPTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:919-781-2281
Mailing Address - Street 1:2601 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6481
Mailing Address - Country:US
Mailing Address - Phone:919-781-2281
Mailing Address - Fax:919-782-0360
Practice Address - Street 1:2601 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6481
Practice Address - Country:US
Practice Address - Phone:919-781-2281
Practice Address - Fax:919-782-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00430332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702986Medicaid
NC7702986Medicaid