MEDICARE: PALMETTO HOME MEDICAL PRODUCTS, INC.

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)	4629	SC
3	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235352238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HOME MEDICAL PRODUCTS, INC.

Provider Business Mailing Address
First Line	:	212 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3120
Country	:	US
Telephone Number	:	843-464-0061
Fax Number	:	843-464-0056

Provider Business Practice Location Address
First Line	:	212 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3120
Country	:	US
Telephone Number	:	843-464-0061
Fax Number	:	843-464-0056

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID STOKES BROOKS IV
Credential	:
Telephone Number	:	843-464-0061

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	06/13/2012

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