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Organization

KANAWHA MEDICAL SUPPLY, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DYANE B PERGERSON (VICE PRESIDENT/OWNER)
(804) 330-5743
Entity
Organization

Contact information

Practice address
14056 RICHMOND HIGHWAY, APPOMATTOX, VA 24522
(434) 352-7671
(434) 352-7673
Mailing address
PO BOX 57, EVERGREEN, VA 23939
(434) 352-7671
(434) 352-7673

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0206009331
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010252130
VA
05
010265207
VA
Enumeration date
08/01/2006
Last updated
03/20/2009
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