Healthcare Provider Details

I. General information

NPI: 1093121493
Provider Name (Legal Business Name): SOUTHEAST MATERNAL MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14323 OCEAN HWY UNIT 4103
PAWLEYS ISLAND SC
29585-4817
US

IV. Provider business mailing address

PO BOX 2036
PAWLEYS ISLAND SC
29585-2036
US

V. Phone/Fax

Practice location:
  • Phone: 843-310-4650
  • Fax:
Mailing address:
  • Phone: 843-310-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4649
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-49698
License Number StateSC

VIII. Authorized Official

Name: JULEE KRECHEL
Title or Position: PRESIDENT
Credential: IBCLC
Phone: 843-310-4650