Provider Demographics
NPI:1164587747
Name:AIRWAY MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:AIRWAY MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-487-2142
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29342-0088
Mailing Address - Country:US
Mailing Address - Phone:864-487-2142
Mailing Address - Fax:864-487-2162
Practice Address - Street 1:1115 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2022
Practice Address - Country:US
Practice Address - Phone:864-487-2142
Practice Address - Fax:864-487-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2014Medicaid
=========OtherEIN
SC4320970001Medicare ID - Type Unspecified