Healthcare Provider Details

I. General information

NPI: 1053344721
Provider Name (Legal Business Name): M&M MEDICAL ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S PENDLETON ST
EASLEY SC
29640-3046
US

IV. Provider business mailing address

PO BOX 7
EASLEY SC
29641-0007
US

V. Phone/Fax

Practice location:
  • Phone: 864-859-5344
  • Fax: 864-859-5346
Mailing address:
  • Phone: 864-859-5344
  • Fax: 864-859-5346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number65-005549
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDE1570
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MR. MICHAEL E. SULLIVAN
Title or Position: PRESIDENT
Credential:
Phone: 864-859-5344