Provider Demographics
NPI:1073509444
Name:PRO-MED 1 INC
Entity Type:Organization
Organization Name:PRO-MED 1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-832-8397
Mailing Address - Street 1:3489 LADSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4330
Mailing Address - Country:US
Mailing Address - Phone:843-832-8397
Mailing Address - Fax:843-832-0552
Practice Address - Street 1:3489 LADSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4330
Practice Address - Country:US
Practice Address - Phone:843-832-8397
Practice Address - Fax:843-832-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332BC3200X, 332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1156Medicaid
SC1190700001Medicare NSC