Healthcare Provider Details

I. General information

NPI: 1265582449
Provider Name (Legal Business Name): EAU CLAIRE MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORTH MAIN ST SUITE #100
COLUMBIA SC
29203-5800
US

IV. Provider business mailing address

4100 NORTH MAIN ST SUITE #100
COLUMBIA SC
29203-5800
US

V. Phone/Fax

Practice location:
  • Phone: 803-735-9849
  • Fax: 803-735-1710
Mailing address:
  • Phone: 803-735-9849
  • Fax: 803-735-1710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number040010861
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number040010861
License Number StateSC

VIII. Authorized Official

Name: MR. MICHAEL L. FINKLIN
Title or Position: OWNER
Credential: CPHT
Phone: 803-735-9849