Organization
CAROLINA MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH WARE BLACK SR. (OWNER)
(704) 730-9500
Entity
Organization
Contact information
Practice address
1802 SHELBY RD, KINGS MTN, NC 28086-8900
(704) 730-9500
(704) 730-9501
Mailing address
1802 SHELBY RD, KINGS MTN, NC 28086-8900
(704) 730-9500
(704) 730-9501
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7703174
—
NC
Enumeration date
02/20/2007
Last updated
08/22/2020
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