Provider Demographics
NPI:1467515031
Name:ADAM MEDICAL SUPPLY & EQUIPMENT LLC
Entity Type:Organization
Organization Name:ADAM MEDICAL SUPPLY & EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-234-2149
Mailing Address - Street 1:POST OFFICE BOX 6822
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29606
Mailing Address - Country:US
Mailing Address - Phone:864-234-2149
Mailing Address - Fax:864-234-5529
Practice Address - Street 1:5 CENTURY DRIVE
Practice Address - Street 2:SUITE 124
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-234-2149
Practice Address - Fax:864-234-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1467515031332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2890Medicaid
SC5958520001Medicare NSC