Provider Demographics
NPI:1033317334
Name:HOME MEDICAL EQUIPMENT REPAIR
Entity Type:Organization
Organization Name:HOME MEDICAL EQUIPMENT REPAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MACK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-423-3900
Mailing Address - Street 1:514 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-4320
Mailing Address - Country:US
Mailing Address - Phone:843-423-3900
Mailing Address - Fax:843-423-1188
Practice Address - Street 1:514 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-4320
Practice Address - Country:US
Practice Address - Phone:843-423-3900
Practice Address - Fax:843-423-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC034085855332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2882Medicaid
SC332B00000XOtherTAXONOMIES
SC5924520001Medicare NSC