Provider Demographics
NPI:1386233146
Name:LYDES MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:LYDES MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-413-2744
Mailing Address - Street 1:1951 PISGAH RD STE 139
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6705
Mailing Address - Country:US
Mailing Address - Phone:843-413-2744
Mailing Address - Fax:843-936-8303
Practice Address - Street 1:1951 PISGAH RD STE 139
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6705
Practice Address - Country:US
Practice Address - Phone:843-413-2744
Practice Address - Fax:843-936-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies