Organization
TOP FORM INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN GALLAN (CEO)
(910) 392-5806
Entity
Organization
Contact information
Practice address
1731 DAWSON ST, WILMINGTON, NC 28403-2326
(910) 392-5806
(910) 452-2913
Mailing address
PO BOX 1594, WILMINGTON, NC 28402-1594
(910) 392-5806
(910) 452-2913
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045X2
BLUE CROSS AND BLUE SHIEL
NC
Enumeration date
09/12/2005
Last updated
08/22/2020
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