Provider Demographics
NPI:1548317472
Name:THE MEDICAL SUPERCENTER OF RALEIGH, INC.
Entity type:Organization
Organization Name:THE MEDICAL SUPERCENTER OF RALEIGH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, JD
Authorized Official - Phone:919-866-0965
Mailing Address - Street 1:PO BOX 90804
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27675-0804
Mailing Address - Country:US
Mailing Address - Phone:919-866-0965
Mailing Address - Fax:919-866-1139
Practice Address - Street 1:3514 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3326
Practice Address - Country:US
Practice Address - Phone:919-866-0965
Practice Address - Fax:919-866-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPENDING332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies