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General NPI Number Information
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NPI Number | 1194040196
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Entity Type | Organization
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Legal Business Name | PROSPERITY MEDICAL SUPPLIES, LLC
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 3031 SCOTSMAN RD STE 13
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City | COLUMBIA
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State | SC
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Zip | 29223-1812
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Country | US
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Telephone | 803-736-5872
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 SCOTSMAN RD STE 13
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City | COLUMBIA
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State | SC
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Zip | 29223-1812
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Country | US
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Telephone | 803-736-5872
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. CAROLYN ANN KENNEDY
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Credential |
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Telephone | 803-736-5872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 20103991339055
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License Number State | SC
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