Provider Demographics
NPI:1831254903
Name:MEDTREX REHABILITATION SPECIALTIES
Entity type:Organization
Organization Name:MEDTREX REHABILITATION SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:SANDERS
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-926-3737
Mailing Address - Street 1:1330 METHODIST PARK ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2842
Mailing Address - Country:US
Mailing Address - Phone:803-926-3737
Mailing Address - Fax:
Practice Address - Street 1:1330 METHODIST PARK RD.
Practice Address - Street 2:STE B
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2842
Practice Address - Country:US
Practice Address - Phone:803-926-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME 219Medicaid
SCDME 219Medicaid