Provider Demographics
NPI:1730236126
Name:RALPH L CLAYTON III
Entity type:Organization
Organization Name:RALPH L CLAYTON III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:800-957-5533
Mailing Address - Street 1:PO BOX 8052
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1052
Mailing Address - Country:US
Mailing Address - Phone:800-957-5533
Mailing Address - Fax:
Practice Address - Street 1:2801-3 WA WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:800-957-5533
Practice Address - Fax:252-291-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00510332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306660001Medicare NSC