Provider Demographics
NPI:1033407820
Name:INNOVATIVE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EENA
Authorized Official - Middle Name:BARR
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-382-4453
Mailing Address - Street 1:692 PROMISED LAND RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-6217
Mailing Address - Country:US
Mailing Address - Phone:843-382-4453
Mailing Address - Fax:
Practice Address - Street 1:692 PROMISED LAND RD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-6217
Practice Address - Country:US
Practice Address - Phone:843-382-4453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC533332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies