Healthcare Provider Details

I. General information

NPI: 1760462428
Provider Name (Legal Business Name): PERFORMANCE MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 GEORGIA AVE
NORTH AUGUSTA SC
29841-3069
US

IV. Provider business mailing address

1635 GEORGIA AVE
NORTH AUGUSTA SC
29841-3069
US

V. Phone/Fax

Practice location:
  • Phone: 803-278-2910
  • Fax: 803-278-5380
Mailing address:
  • Phone: 803-278-2910
  • Fax: 803-278-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN M HESTER
Title or Position: OWNER
Credential:
Phone: 803-278-2910