Organization
KANAWHA MEDICAL SUPPLY INC
Active
Organization
KANAWHA MEDICAL SUPPLY INC
Active
Other names
Kanawha Healthcare Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DYANE B PERGERSON (OWNER/VICE PRESIDENT)
(434) 352-7671
Entity
Organization
Contact information
Practice address
7009 FOREST HILL AVE, RICHMOND, VA 23225-1607
(804) 330-5937
(804) 330-7149
Mailing address
7009 FOREST HILL AVE, RICHMOND, VA 23225-1607
(804) 330-5743
(804) 330-7149
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0087009400
—
VA
05
—
0087720295
—
VA
05
—
009132287
—
VA
05
—
0102164867
—
VA
05
—
0102181440
—
VA
05
—
0102181952
—
VA
05
—
0102224273
—
VA
05
—
1437165057
—
VA
01
—
231350
ANTHEM BCBS
—
Enumeration date
12/28/2005
Last updated
04/10/2013
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