Provider Demographics
NPI:1417924515
Name:DURAMED MEDICAL SERVICES
Entity Type:Organization
Organization Name:DURAMED MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-737-0500
Mailing Address - Street 1:1543 15 STREET
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-3459
Mailing Address - Country:US
Mailing Address - Phone:706-737-0500
Mailing Address - Fax:706-737-6323
Practice Address - Street 1:1543 15 STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-3459
Practice Address - Country:US
Practice Address - Phone:706-737-0500
Practice Address - Fax:706-737-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
GA1003498332BC3200X
GA005962332BX2000X
GAC18145335E00000X
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 Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00289473AMedicaid
SCDME045Medicaid
GA00289473BMedicaid
SCDME045Medicaid