Provider Demographics
NPI:1235352238
Name:PALMETTO HOME MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:PALMETTO HOME MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STOKES
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:843-464-0061
Mailing Address - Street 1:212 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3120
Mailing Address - Country:US
Mailing Address - Phone:843-464-0061
Mailing Address - Fax:843-464-0056
Practice Address - Street 1:212 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3120
Practice Address - Country:US
Practice Address - Phone:843-464-0061
Practice Address - Fax:843-464-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
SC4629332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1420Medicaid
SC1244180001Medicare ID - Type Unspecified