Provider Demographics
NPI:1255390993
Name:INTRAMED PLUS, INC
Entity type:Organization
Organization Name:INTRAMED PLUS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CFO/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-679-6137
Mailing Address - Street 1:112 SALUDA RIDGE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3455
Mailing Address - Country:US
Mailing Address - Phone:803-794-0200
Mailing Address - Fax:803-794-1302
Practice Address - Street 1:112 SALUDA RIDGE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3455
Practice Address - Country:US
Practice Address - Phone:803-794-0200
Practice Address - Fax:803-794-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC032244526000220433336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME296Medicaid
SC60-01522OtherCAROLINA CARE PLAN PROVID
SC4219792OtherNCPDP/NABP PROVIDER #
SC726043Medicaid
SC20016931OtherSELECT HEALTH PROVIDER #
SC8511179OtherAETNA INSURANCE PROVIDER
SC726043Medicaid