Provider Demographics
NPI:1134208341
Name:SOUTH CAROLINA BELLAMY GROUP, INC.
Entity type:Organization
Organization Name:SOUTH CAROLINA BELLAMY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-942-6602
Mailing Address - Street 1:1701 W FLAGLER ST
Mailing Address - Street 2:SUITE 338
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2098
Mailing Address - Country:US
Mailing Address - Phone:786-942-6602
Mailing Address - Fax:
Practice Address - Street 1:1701 W FLAGLER ST
Practice Address - Street 2:SUITE 338
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2098
Practice Address - Country:US
Practice Address - Phone:786-942-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER