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General NPI Number Information
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NPI Number | 1073509444
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Entity Type | Organization
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Legal Business Name | PRO-MED 1 INC
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 3489 LADSON RD SUITE B
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City | LADSON
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State | SC
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Zip | 29456-4330
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Country | US
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Telephone | 843-832-8397
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Fax | 843-832-0552
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Provider Business Mailing Address
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Address Line | 3489 LADSON RD SUITE B
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City | LADSON
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State | SC
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Zip | 29456-4330
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Country | US
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Telephone | 843-832-8397
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Fax | 843-832-0552
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBORAH SUE SLOCUM
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Credential |
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Telephone | 843-832-8397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | SC
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