Healthcare Provider Details

I. General information

NPI: 1760306278
Provider Name (Legal Business Name): PURE E.A.G.L.E
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 JOHNSON RD
RIDGELAND SC
29936-3710
US

IV. Provider business mailing address

244 JOHNSON RD
RIDGELAND SC
29936-3710
US

V. Phone/Fax

Practice location:
  • Phone: 843-368-0735
  • Fax: 843-368-0735
Mailing address:
  • Phone: 843-368-0735
  • Fax: 843-368-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: EBONY YOUMANS
Title or Position: OWNER
Credential:
Phone: 843-368-0735