MEDICARE: KEVIN D EPPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor	RBS65772	SC

General Provider Information

NPI Number	:	1205671120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN D EPPS

Provider Business Mailing Address
First Line	:	521 FREEDOM AVE
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-3613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 FREEDOM AVE
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-3613
Country	:	US
Telephone Number	:	843-496-3975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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