MEDICARE: PERFORMANCE MEDICAL SUPPLY INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760462428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	553 EDGEFIELD RD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-2414
Country	:	US
Telephone Number	:	803-278-2910
Fax Number	:	803-278-5380

Provider Business Practice Location Address
First Line	:	553 EDGEFIELD RD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-2414
Country	:	US
Telephone Number	:	803-278-2910
Fax Number	:	803-278-5380

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEVIN M HESTER
Credential	:
Telephone Number	:	803-278-2910

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	02/02/2026

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