Healthcare Provider Details

I. General information

NPI: 1376523324
Provider Name (Legal Business Name): GRACE DIABETIC AND MEDICAL SUPPLY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 MONTICELLO RD
COLUMBIA SC
29203-3448
US

IV. Provider business mailing address

5010 MONTICELLO RD
COLUMBIA SC
29203-3448
US

V. Phone/Fax

Practice location:
  • Phone: 803-361-1955
  • Fax: 803-754-8844
Mailing address:
  • Phone: 803-361-1955
  • Fax: 803-754-8844

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA BISHOP HAMMONDS
Title or Position: OWNER
Credential:
Phone: 803-361-1955