Provider Demographics
NPI:1891987897
Name:RJS SAS SHOES INC
Entity Type:Organization
Organization Name:RJS SAS SHOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-782-3662
Mailing Address - Street 1:3306 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4024
Mailing Address - Country:US
Mailing Address - Phone:803-782-3668
Mailing Address - Fax:803-787-7258
Practice Address - Street 1:3306 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4024
Practice Address - Country:US
Practice Address - Phone:803-782-3668
Practice Address - Fax:803-787-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4092910001Medicare NSC