Provider Demographics
NPI:1043372493
Name:MEDICAL SUPPLY SUPERSTORE LLC
Entity type:Organization
Organization Name:MEDICAL SUPPLY SUPERSTORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCIOSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-220-0740
Mailing Address - Street 1:3306 GUESS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2106
Mailing Address - Country:US
Mailing Address - Phone:919-220-0740
Mailing Address - Fax:919-220-0308
Practice Address - Street 1:3306 GUESS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2106
Practice Address - Country:US
Practice Address - Phone:919-220-0740
Practice Address - Fax:919-220-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00187332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702681Medicaid
NC7702681Medicaid