Healthcare Provider Details

I. General information

NPI: 1649550963
Provider Name (Legal Business Name): THE WELBOURNE GROUP,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 GARNERS FERRY RD
COLUMBIA SC
29209-1609
US

IV. Provider business mailing address

6830 GARNERS FERRY RD
COLUMBIA SC
29209-1609
US

V. Phone/Fax

Practice location:
  • Phone: 803-729-0122
  • Fax: 866-771-6123
Mailing address:
  • Phone: 803-729-0122
  • Fax: 866-771-6123

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 Number
License Number State

VIII. Authorized Official

Name: MR. JOHN W OWEN JR.
Title or Position: PRESIDENT
Credential: CO, CFO, CFTS
Phone: 803-728-0122