Healthcare Provider Details

I. General information

NPI: 1578704318
Provider Name (Legal Business Name): EXPRESS MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 PRATHER PARK DR UNIT 2
MYRTLE BEACH SC
29588-7911
US

IV. Provider business mailing address

195 PRATHER PARK DR UNIT 2
MYRTLE BEACH SC
29588-7911
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-4271
  • Fax:
Mailing address:
  • Phone: 843-236-4271
  • 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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JUSTIL CRUZ
Title or Position: VICE-PRESIDENT
Credential:
Phone: 973-926-1400