Healthcare Provider Details

I. General information

NPI: 1952733644
Provider Name (Legal Business Name): CAMPBELL MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

603 WILLIE HODGE RD
MULLINS SC
29574-6129
US

IV. Provider business mailing address

603 WILLIE HODGE RD
MULLINS SC
29574-6129
US

V. Phone/Fax

Practice location:
  • Phone: 843-433-2512
  • Fax:
Mailing address:
  • Phone: 843-433-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SARAH CAMPBELL
Title or Position: OWNER/CEO
Credential:
Phone: 843-433-2512