Provider Demographics
NPI:1336197482
Name:MEDICAL SELECT, INC.
Entity Type:Organization
Organization Name:MEDICAL SELECT, INC.
Other - Org Name:NEB DOCTORS OF SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-588-9630
Mailing Address - Street 1:PO BOX 922189
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-2189
Mailing Address - Country:US
Mailing Address - Phone:888-588-9630
Mailing Address - Fax:888-835-3354
Practice Address - Street 1:101 WESTPARK BLVD
Practice Address - Street 2:STE. A-2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3858
Practice Address - Country:US
Practice Address - Phone:803-772-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65-006689332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM0052Medicaid
SC0288120001Medicare ID - Type Unspecified