Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 332B00000X | Durable Medical Equipment & Medical Supplies | | 000460932 | NORTH CAROLINA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 3810018145 | MEDICAID | WEST VIRGINIA | |
| 2 | 8112816-1714 | OTHER | UTAH | BOARD OF PHARMACY LICENSE - CLASS D |
| 3 | 10039793 | OTHER | NORTH CAROLINA | CHARLOTTE NC ALARM PERMIT |
| 4 | 1487858239 | MEDICAID | MICHIGAN | |
| 5 | 5512379 | MEDICAID | MARYLAND | |
| 6 | 600731245 | OTHER | NORTH CAROLINA | DEPARTMENT OF REVENUE - CERTIFICATE OF REGISTRATION |
| 7 | 10026103000 | MEDICAID | NEBRASKA | |
| 8 | 1487858239 | MEDICAID | MINNESOTA | |
| 9 | 1487858239 | MEDICAID | WYOMING | |
| 10 | 2164791 | MEDICAID | LOUISIANA | |
| 11 | =========001 | MEDICAID | ILLINOIS | |
| 12 | 01543 | OTHER | NORTH CAROLINA | BOARD OF PHARMACY LICENSE |
| 13 | 710177910 | MEDICAID | KENTUCKY | |
| 14 | 7705026 | MEDICAID | NORTH CAROLINA | |
| 15 | MS002NC | MEDICAID | ALASKA | |
| 16 | 08177/11.1 | OTHER | MISSISSIPPI | BOARD OF PHARMACY LICENSE |
| 17 | 130448 | MEDICAID | ALABAMA | |
| 18 | 1487858239 | MEDICAID | ARIZONA | |
| 19 | MP00833 | OTHER | NEVADA | BOARD OF PHARMACY LICENSE |
| 20 | 1487858239 | MEDICAID | MONTANA | |
| 21 | 17282 | OTHER | IDAHO | BOARD OF PHARMACY LICENSE |
| 22 | 99495 | OTHER | NORTH CAROLINA | BUSINESS LICENSE - CITY OF CHARLOTTE/MECKLENBURG COUNTY PRIVILEGE LICENSE |
| 23 | P-77146365 | MEDICAID | IOWA | |
| 24 | 003112629A | MEDICAID | GEORGIA | |
| 25 | 1096 | OTHER | ALABAMA | BOARD OF PHARMACY LICENSE |
| 26 | 1487858239 | MEDICAID | MAINE | |
| 27 | DM0795 | MEDICAID | SOUTH CAROLINA | |
| 28 | 1487858239 | MEDICAID | WASHINGTON | |
| 29 | 620001 | MEDICAID | RHODE ISLAND | |
| 30 | LPI-201037580 A | MEDICAID | INDIANA | |
