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 | 332BP3500X | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 05113 | NORTH CAROLINA | No |
| 2 | 333600000X | Pharmacy | | 05113 | NORTH CAROLINA | No |
| 3 | 251F00000X | Home Infusion | | 05113 | NORTH CAROLINA | No |
| 4 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | NORTH CAROLINA | No |
| 5 | 332BC3200X | Durable Medical Equipment & Medical Supplies | Customized Equipment | 00786 | NORTH CAROLINA | No |
| 6 | 3336H0001X | Pharmacy | Home Infusion Therapy Pharmacy | 0533 | NORTH CAROLINA | No |
| 7 | 332BX2000X | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 00786 | 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 | 6800401 | MEDICAID | NORTH CAROLINA | |
| 2 | 7702497 | MEDICAID | NORTH CAROLINA | |
| 3 | 153369400 | OTHER | NORTH CAROLINA | BLACK LUNG |
| 4 | 0494A | OTHER | NORTH CAROLINA | BCBSNC IV |
| 5 | 8295 | OTHER | NORTH CAROLINA | PARTNERS |
| 6 | 1013981 | OTHER | NORTH CAROLINA | UHC ACM |
| 7 | 0347007 | MEDICAID | NORTH CAROLINA | |
| 8 | 0486P | OTHER | NORTH CAROLINA | BCBSNC DME |
| 9 | 0244470001 | OTHER | NORTH CAROLINA | NATIONAL SUPPLIER CLEARINGHOUSE |
| 10 | 3429669 | OTHER | NORTH CAROLINA | NCPDP |
