Provider Demographics
NPI:1639149727
Name:HAWTHORNE MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:HAWTHORNE MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-227-4468
Mailing Address - Street 1:1520 TAYLOR ST # A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2901
Mailing Address - Country:US
Mailing Address - Phone:803-227-4468
Mailing Address - Fax:803-227-4468
Practice Address - Street 1:1520 TAYLOR ST # A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2901
Practice Address - Country:US
Practice Address - Phone:803-227-4468
Practice Address - Fax:803-227-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC556026Medicaid
SC0160970001Medicare NSC