Dove Medical Supply Retail LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DOVE MEDICAL SUPPLY RETAIL LLC

Practice address

2172 Lawndale Dr
Greensboro, NC 27408-7102

Phone

(336) 574-1489

NPI assigned

Nov 9, 2020

Organization subpart

No

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

Authorized official

Name

Annen Southerland

Title

Director of Operations

Phone

(336) 971-5890

Specialties & licenses 1

Addresses

Other names 2

• Dove Medical Supply Retail LLC Former legal business name
• Dove Medical Supply Retail LLC - Greensboro Other name

Locations

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

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623801600000",
    "number": "1801498571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 S EASTWAY DR",
            "city": "TROUTMAN",
            "state": "NC",
            "postal_code": "281669609",
            "telephone_number": "704-508-2016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2172 LAWNDALE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087102",
            "telephone_number": "336-574-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOVE MEDICAL SUPPLY RETAIL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-09",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A",
        "authorized_official_last_name": "SOUTHERLAND",
        "authorized_official_first_name": "ANNEN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "336-971-5890"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dove Medical Supply Retail LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Dove Medical Supply Retail LLC - Greensboro",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Garrett Samuel Douglas
• Vicki Yvonne Douglas, RN
• Wendy Michele Douglas, MA, LCMHCA, NCC
• Anastassia Doutova, M.D.
• Dove Medical Supply Retail LLC
• Dove Youthology Aesthetic Institute, PLLC
• Krystle Horne Dove, DNP, APRN, AGPCNP-BC
• Tasha Anita Dove, NP
• Kevin Glenn Dover, MD
• Jaclyn Melanie Dovico, M.D.

• Durable Medical Equipment & Medical Supplies in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Durable Medical Equipment & Medical Supplies in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.