NPIMap

Organization Active NPI

180 Medical, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Charlotte, NC
National Provider Identifier
1265760920
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
02000 Issued in NC
Legal business name
180 MEDICAL, INC.
Practice address
717 Atando Ave
Suite J
Charlotte, NC 28206-1915
Phone
(980) 207-1156
Fax
(888) 718-0633
NPI assigned
Nov 18, 2009
Last updated
May 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeffery B Hendrix
Title
Cfo
Phone
(405) 443-2985

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 02000 NC Primary
Customized Equipment (DME) 332BC3200X 02000 NC

Addresses

Primary practice location

717 Atando Ave
Suite J
Charlotte, NC 28206-1915

Mailing address

8516 NW Expressway
Oklahoma City, OK 73162-6010
Phone (877) 688-2729

Other identifiers 2

IdentifierTypeStateIssuer
7705118MedicaidNC
DE2916MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210608000247 NC DME Supplier - Medical Supply Company 7810101920 Practice locations: Charlotte, NC

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
180 Medical, Inc717 Atando Ave, Charlotte, NC 28206-1903(877) 688-2729 Commodes, Urinals, Bedpans|Heat & Cold Applications|Canes and/or Crutches|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Surgical Dressings|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 2010

National Provider Directory

National Provider Directory
Tax ID family
180 Medical Inc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

717 Atando Ave
Ste J
Charlotte, NC 28206
Phone (980) 207-1156

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1265760920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8516 NW EXPRESSWAY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731626010",
            "telephone_number": "877-688-2729",
            "fax_number": "888-718-0633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 ATANDO AVE",
            "address_2": "SUITE J",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282061915",
            "telephone_number": "980-207-1156",
            "fax_number": "888-718-0633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "180 MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-18",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "HENDRIX",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "405-443-2985",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": "02000",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": "02000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7705118",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE2916",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.