Healthcare Provider Details

I. General information

NPI: 1730407347
Provider Name (Legal Business Name): AMERICAN HOMEPATIENT OF KINGSTREE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W MILL ST
KINGSTREE SC
29556-3236
US

IV. Provider business mailing address

PO BOX 530640
ATLANTA GA
30353-0640
US

V. Phone/Fax

Practice location:
  • Phone: 843-354-7090
  • Fax: 843-354-9050
Mailing address:
  • Phone: 843-821-8525
  • Fax: 843-821-0982

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 TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG MCCARTHY
Title or Position: COO
Credential:
Phone: 727-530-7700