Provider Demographics
NPI:1689776981
Name:NOTTAP, INC.
Entity Type:Organization
Organization Name:NOTTAP, INC.
Other - Org Name:BUFORD STREET HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:864-488-3036
Mailing Address - Street 1:113 W BUFORD ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-3001
Mailing Address - Country:US
Mailing Address - Phone:864-488-2735
Mailing Address - Fax:864-488-0316
Practice Address - Street 1:113 W BUFORD ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3001
Practice Address - Country:US
Practice Address - Phone:864-488-2735
Practice Address - Fax:864-488-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65004896332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1519Medicaid
SCDE1519Medicaid