Provider Demographics
NPI:1831153170
Name:FLORENCE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:FLORENCE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORBERTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-669-2009
Mailing Address - Street 1:3126 ONE HALF S CASHUA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6302
Mailing Address - Country:US
Mailing Address - Phone:843-669-2009
Mailing Address - Fax:843-277-0618
Practice Address - Street 1:3126 ONE HALF S CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6302
Practice Address - Country:US
Practice Address - Phone:843-669-2009
Practice Address - Fax:843-277-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC053294332B00000X, 332BN1400X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1028800OtherBLUECHOICE GOLD
SCDE2721Medicaid
SC5615020001Medicare ID - Type Unspecified