Healthcare Provider Details

I. General information

NPI: 1558289389
Provider Name (Legal Business Name): THREASA MICHELE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10149 TWO NOTCH RD STE E
COLUMBIA SC
29229-4213
US

IV. Provider business mailing address

9600 TWO NOTCH RD STE 5
COLUMBIA SC
29223-1612
US

V. Phone/Fax

Practice location:
  • Phone: 866-877-2552
  • Fax: 866-877-2552
Mailing address:
  • Phone: 866-877-2552
  • Fax: 866-877-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: