Healthcare Provider Details

I. General information

NPI: 1366444374
Provider Name (Legal Business Name): WINYAH HOME MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CHURCH ST
GEORGETOWN SC
29440-3201
US

IV. Provider business mailing address

1101 CHURCH ST
GEORGETOWN SC
29440-3201
US

V. Phone/Fax

Practice location:
  • Phone: 843-520-0300
  • Fax: 843-520-0301
Mailing address:
  • Phone: 843-520-0300
  • Fax: 843-520-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number022150084
License Number StateSC

VIII. Authorized Official

Name: MRS. DANA L WHITLOCK
Title or Position: DIRECTOR
Credential:
Phone: 843-520-0300