Provider Demographics
NPI:1952397788
Name:PIEDMONT MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:PIEDMONT MEDICAL SUPPLY, INC
Other - Org Name:PIEDMONT MEDICAL & PROSTHETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-585-2501
Mailing Address - Street 1:1486 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-2204
Mailing Address - Country:US
Mailing Address - Phone:864-585-2501
Mailing Address - Fax:864-585-2714
Practice Address - Street 1:1486 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2204
Practice Address - Country:US
Practice Address - Phone:864-585-2501
Practice Address - Fax:864-585-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1040Medicaid
SC1140750001Medicare ID - Type UnspecifiedMEDICARE HICN