Provider Demographics
NPI:1831575703
Name:EYTAW MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:EYTAW MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-614-9023
Mailing Address - Street 1:505 N HIGHWAY 52
Mailing Address - Street 2:STE D 103
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3151
Mailing Address - Country:US
Mailing Address - Phone:803-614-9023
Mailing Address - Fax:
Practice Address - Street 1:505 N HIGHWAY 52
Practice Address - Street 2:STE D 103
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3151
Practice Address - Country:US
Practice Address - Phone:803-614-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies