Provider Demographics
NPI:1992958417
Name:EXPRESS MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:EXPRESS MEDICAL SUPPLY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V P
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:OGBONNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-876-4949
Mailing Address - Street 1:1801 SAINT ALBANS DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6279
Mailing Address - Country:US
Mailing Address - Phone:919-876-4949
Mailing Address - Fax:919-876-4946
Practice Address - Street 1:1801 SAINT ALBANS DR
Practice Address - Street 2:SUITE G
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6279
Practice Address - Country:US
Practice Address - Phone:919-876-4949
Practice Address - Fax:919-876-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6392120001Medicare NSC