Provider Demographics
NPI:1043279789
Name:INTRAMED PLUS, INC.
Entity Type:Organization
Organization Name:INTRAMED PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-794-0200
Mailing Address - Street 1:4995 LACROSS RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6542
Mailing Address - Country:US
Mailing Address - Phone:843-763-2080
Mailing Address - Fax:803-763-9916
Practice Address - Street 1:4995 LACROSS RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6542
Practice Address - Country:US
Practice Address - Phone:843-763-2080
Practice Address - Fax:803-763-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010619841650433336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4224743OtherNCPDP/NABP PROVIDER #
SCDE1142Medicaid
SC740306OtherSC MEDICAID RX PROVIDER #
SCDE1142Medicaid