MEDICARE: EXPERT HOME MEDICAL. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	026540789	SC

General Provider Information

NPI Number	:	1063727691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPERT HOME MEDICAL. LLC

Provider Business Mailing Address
First Line	:	4661 SOCASTEE BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7211
Country	:	US
Telephone Number	:	843-294-4444
Fax Number	:	843-294-4445

Provider Business Practice Location Address
First Line	:	4661 SOCASTEE BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7211
Country	:	US
Telephone Number	:	843-294-4444
Fax Number	:	843-294-4445

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DANA L WHITLOCK
Credential	:
Telephone Number	:	843-294-4444

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/06/2010

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