Healthcare Provider Details

I. General information

NPI: 1750786604
Provider Name (Legal Business Name): KEYMED CPAP SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 DRIFTWOOD AVE
ELGIN SC
29045-8547
US

IV. Provider business mailing address

133 DRIFTWOOD AVE
ELGIN SC
29045-8547
US

V. Phone/Fax

Practice location:
  • Phone: 803-463-9003
  • Fax:
Mailing address:
  • Phone: 803-463-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number028126894
License Number StateSC

VIII. Authorized Official

Name: LIKESHIA OUTTEN
Title or Position: OWNER/RESPIRATORY THERAPIST
Credential:
Phone: 803-463-9003