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General NPI Number Information
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NPI Number | 1356552871
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Entity Type | Organization
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Legal Business Name | FIRST IMPRESSIONS INCONTINENT AND MEDICAL SUPPLIES
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5 DEER TRACE CT
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City | WINNSBORO
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State | SC
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Zip | 29180-6004
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Country | US
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Telephone | 803-735-3050
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Fax | 803-735-3059
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Provider Business Mailing Address
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Address Line | 5 DEER TRACE CT
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City | WINNSBORO
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State | SC
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Zip | 29180-6004
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Country | US
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Telephone | 803-635-2447
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Fax | 803-735-3050
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELANIE RICHMOND PEARSON
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Credential |
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Telephone | 803-735-3050
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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 | EN2021
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License Number State | SC
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