# CAROLINA MEDICAL SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720123862
- **Authorized official:** MR. KENNETH WARE BLACK SR. (OWNER)
- **Authorized official phone:** (704) 730-9500

## Contact information

- **Practice address:** 1802 SHELBY RD, KINGS MTN, NC 28086-8900
- **Practice address phone:** (704) 730-9500
- **Practice address fax:** (704) 730-9501
- **Mailing address:** 1802 SHELBY RD, KINGS MTN, NC 28086-8900
- **Mailing address phone:** (704) 730-9500
- **Mailing address fax:** (704) 730-9501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | — | NC | Yes |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 08/22/2020