Healthcare Provider Details

I. General information

NPI: 1699094664
Provider Name (Legal Business Name): ESSEX MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TOWNE DR SUITE 246
BLUFFTON SC
29910-4204
US

IV. Provider business mailing address

20 TOWNE DR SUITE 246
BLUFFTON SC
29910-4204
US

V. Phone/Fax

Practice location:
  • Phone: 843-837-3758
  • Fax: 866-936-8405
Mailing address:
  • Phone: 843-837-3758
  • Fax: 866-936-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberAK2734
License Number StateSC

VIII. Authorized Official

Name: MR. ANDREW H. KEIL
Title or Position: PRESIDENT
Credential:
Phone: 843-837-3758