Provider Demographics
NPI:1265477764
Name:BRIC PROFESSIONAL SERVICES,INC
Entity Type:Organization
Organization Name:BRIC PROFESSIONAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-347-0352
Mailing Address - Street 1:106 WACCAMAW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8989
Mailing Address - Country:US
Mailing Address - Phone:843-347-0352
Mailing Address - Fax:843-347-6063
Practice Address - Street 1:106 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8989
Practice Address - Country:US
Practice Address - Phone:843-347-0352
Practice Address - Fax:843-347-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6507663332B00000X
SC65007663332BC3200X, 332BP3500X, 332BX2000X
SC500048943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20048290Medicaid
SCDME222Medicaid
SCDME222Medicaid
SC0259280001Medicare ID - Type UnspecifiedPALMETTO GBA