Provider Demographics
NPI:1043303720
Name:MEDFIRST DIABETIC SHOES & SUPPLIES
Entity Type:Organization
Organization Name:MEDFIRST DIABETIC SHOES & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-939-1916
Mailing Address - Street 1:112-K WHITE OAK LANE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29061
Mailing Address - Country:US
Mailing Address - Phone:803-939-1916
Mailing Address - Fax:866-736-9456
Practice Address - Street 1:112-K WHITE OAK LANE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29061
Practice Address - Country:US
Practice Address - Phone:803-939-1916
Practice Address - Fax:866-736-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2594Medicaid
SCDE2594Medicaid