Provider Demographics
NPI:1326107517
Name:BOMAC INC
Entity Type:Organization
Organization Name:BOMAC INC
Other - Org Name:MOMENTUM MEDICAL BRACE & LIMB
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-423-2337
Mailing Address - Street 1:2876 EAST HWY 76
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574
Mailing Address - Country:US
Mailing Address - Phone:843-423-2337
Mailing Address - Fax:843-423-2338
Practice Address - Street 1:BOMAC INC
Practice Address - Street 2:2876 E HWY 76
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6036
Practice Address - Country:US
Practice Address - Phone:843-423-2337
Practice Address - Fax:843-423-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1858Medicaid