MEDICINE MART LTC, LLC
NPI: 1174639041
· TABOR CITY, NC 28463
· Specialty Pharmacy
· NPI assigned 08/22/2006
Provider Details
| Authorized Official | KOONCE, STERLING (MANAGING AGENT) |
| NPI Enumeration Date | 08/22/2006 |
Related Entities
Other providers sharing the same authorized official: KOONCE, STERLING
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
30 |
$419.85 |
| 2019 |
31 |
$529.12 |
| 2020 |
157 |
$3K |
| 2021 |
12 |
$109.80 |
| 2022 |
138 |
$3K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0064A |
|
41 |
40 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
137 |
136 |
$2K |
| 90756 |
|
91 |
88 |
$2K |
| 90686 |
|
30 |
30 |
$587.34 |
| 90688 |
|
28 |
26 |
$353.82 |
| 91306 |
|
41 |
40 |
$0.00 |