Provider Demographics
NPI:1912132770
Name:ENCORE SUPPLY AND SERVICES,INC
Entity Type:Organization
Organization Name:ENCORE SUPPLY AND SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-707-1997
Mailing Address - Street 1:2518 DUBARD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2242
Mailing Address - Country:US
Mailing Address - Phone:803-707-1997
Mailing Address - Fax:
Practice Address - Street 1:2611 FOREST DR
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2379
Practice Address - Country:US
Practice Address - Phone:803-707-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0739824332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies