Provider Demographics
NPI:1295765949
Name:MEDICALLY LINKED DME, LLC
Entity type:Organization
Organization Name:MEDICALLY LINKED DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:RICHMOND
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-807-9533
Mailing Address - Street 1:101 RICE BENT WAY
Mailing Address - Street 2:UNIT 12
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6849
Mailing Address - Country:US
Mailing Address - Phone:803-807-9533
Mailing Address - Fax:877-903-1383
Practice Address - Street 1:101 RICE BENT WAY
Practice Address - Street 2:UNIT 12
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-6849
Practice Address - Country:US
Practice Address - Phone:803-807-9533
Practice Address - Fax:877-903-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2185332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2717Medicaid
6020420001Medicare NSC