Provider Demographics
NPI:1649241621
Name:RELIABLE MEDICAL EQUIPMENT OF SUMMERVILLE, LLC
Entity Type:Organization
Organization Name:RELIABLE MEDICAL EQUIPMENT OF SUMMERVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-881-4928
Mailing Address - Street 1:108A THOMAS CARY CT
Mailing Address - Street 2:
Mailing Address - City:WANDO
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7940
Mailing Address - Country:US
Mailing Address - Phone:843-881-4928
Mailing Address - Fax:843-884-8005
Practice Address - Street 1:301 OAKBROOK LN
Practice Address - Street 2:STE 315
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8257
Practice Address - Country:US
Practice Address - Phone:843-875-2215
Practice Address - Fax:843-875-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2133Medicaid
SC=========OtherBLUE CROSS BLUE SHIELD
SC=========OtherOTHER HEALTH PLANS
SC4437490001Medicare ID - Type Unspecified