Provider Demographics
NPI:1639449127
Name:LOW COUNTRY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:LOW COUNTRY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-333-8582
Mailing Address - Street 1:2339 DAISY RD
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-6741
Mailing Address - Country:US
Mailing Address - Phone:843-333-8582
Mailing Address - Fax:
Practice Address - Street 1:2339 DAISY RD
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-6741
Practice Address - Country:US
Practice Address - Phone:843-333-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies