Healthcare Provider Details

I. General information

NPI: 1457727398
Provider Name (Legal Business Name): SUNSHINE MEDICAL &SHOES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 GLENMORE WAY
FLORENCE SC
29505-6851
US

IV. Provider business mailing address

4001 E PALMETTO ST STE 4
FLORENCE SC
29506-4213
US

V. Phone/Fax

Practice location:
  • Phone: 954-709-4476
  • Fax: 843-669-9258
Mailing address:
  • Phone: 843-206-3800
  • Fax: 843-669-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateSC

VIII. Authorized Official

Name: BARBARA NIXON
Title or Position: OWNER
Credential:
Phone: 954-709-4476