Organization
MED-CO DIABETIC SUPPLIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ALFONSO GILLIAM (OWNER / GENERAL MANAGER)
(336) 661-1669
Entity
Organization
Contact information
Practice address
4964 UNIVERSITY PKWY, SUITE-107, WINSTON-SALEM, NC 27106-2809
(336) 661-1669
(336) 661-1678
Mailing address
PO BOX 4143, WINSTON-SALEM, NC 27115-4143
(336) 661-1669
(336) 661-1678
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
600424547
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7703544
—
NC
Enumeration date
03/02/2006
Last updated
06/08/2009
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