=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447421979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BULLDOG COMMERCIAL CONSTRUCTION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2008
-----------------------------------------------------
Last Update Date | 03/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 FOXCROFT LN
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29485-8623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-821-9889
-----------------------------------------------------
Fax | 843-821-9889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 FOXCROFT LN
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29485-8623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-821-9889
-----------------------------------------------------
Fax | 843-821-9889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. PHILLIP STEELE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-821-9889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | G112772
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------