Provider Demographics
NPI:1851597488
Name:PERFORMANCE MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-791-5904
Mailing Address - Street 1:622 OLD TROLLEY RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5674
Mailing Address - Country:US
Mailing Address - Phone:843-486-5274
Mailing Address - Fax:843-486-5279
Practice Address - Street 1:622 OLD TROLLEY RD
Practice Address - Street 2:SUITE 126
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5674
Practice Address - Country:US
Practice Address - Phone:843-486-5274
Practice Address - Fax:843-486-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies