Provider Demographics
NPI:1942457833
Name:PATTERSON MEDICAL LLC
Entity Type:Organization
Organization Name:PATTERSON MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-465-5885
Mailing Address - Street 1:301 WHISPERING GLEN CT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2766
Mailing Address - Country:US
Mailing Address - Phone:803-465-5885
Mailing Address - Fax:
Practice Address - Street 1:229 N PARSON ST
Practice Address - Street 2:SUITE 331
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6451
Practice Address - Country:US
Practice Address - Phone:803-465-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies