MEDICARE: MRS. RUTH ROWE MCCLARY

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679758361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH ROWE MCCLARY

Provider Business Mailing Address
First Line	:	2335 OAKCREST RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-3836
Country	:	US
Telephone Number	:	803-361-6932
Fax Number	:	803-788-9181

Provider Business Practice Location Address
First Line	:	2335 OAKCREST RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-3836
Country	:	US
Telephone Number	:	803-361-6932
Fax Number	:	803-788-9181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2008
Last Update Date	:	01/01/2008

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