Healthcare Provider Details

I. General information

NPI: 1639149727
Provider Name (Legal Business Name): HAWTHORNE MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 TAYLOR ST # A
COLUMBIA SC
29201-2901
US

IV. Provider business mailing address

1520 TAYLOR ST # A
COLUMBIA SC
29201-2901
US

V. Phone/Fax

Practice location:
  • Phone: 803-227-4468
  • Fax: 803-227-4468
Mailing address:
  • Phone: 803-227-4468
  • Fax: 803-227-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY ANN CANNAN
Title or Position: DIRECTOR
Credential:
Phone: 803-227-4468