Organization
MEDEMPORIUM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYANN BISHOP LARGEN R.PH. (CHIEF OPERATING OFFICER)
(704) 535-2201
Entity
Organization
Contact information
Practice address
1300 CROSSBEAM DR, CHARLOTTE, NC 28217-2800
(704) 535-2201
(704) 535-3836
Mailing address
1300 CROSSBEAM DR, CHARLOTTE, NC 28217-2800
(704) 535-2201
(704) 535-3836
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
00358
NC
332BX2000X
Oxygen Equipment & Supplies (DME)
00358
NC
333600000X
Pharmacy
7135
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04155
BLUE CROSS BLUE SHIELD
NC
05
—
7702784
—
NC
Enumeration date
12/05/2005
Last updated
11/12/2020
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