Provider Demographics
NPI:1982006342
Name:MATTRESS OUTLET OF UPSTATE LLC
Entity Type:Organization
Organization Name:MATTRESS OUTLET OF UPSTATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-329-8999
Mailing Address - Street 1:1170 WOODRUFF RD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4154
Mailing Address - Country:US
Mailing Address - Phone:864-329-8999
Mailing Address - Fax:864-329-8668
Practice Address - Street 1:1170 WOODRUFF RD
Practice Address - Street 2:UNIT 5
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4154
Practice Address - Country:US
Practice Address - Phone:864-329-8999
Practice Address - Fax:864-329-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies