MEDICARE: MEDICALLY LINKED DME, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	2185	SC

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	:	1295765949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICALLY LINKED DME, LLC

Provider Business Mailing Address
First Line	:	101 RICE BENT WAY
Second Line	:	UNIT 12
City	:	COLUMBIA
State	:	SC
Zip	:	29229-6849
Country	:	US
Telephone Number	:	803-807-9533
Fax Number	:	877-903-1383

Provider Business Practice Location Address
First Line	:	101 RICE BENT WAY
Second Line	:	UNIT 12
City	:	COLUMBIA
State	:	SC
Zip	:	29229-6849
Country	:	US
Telephone Number	:	803-807-9533
Fax Number	:	877-903-1383

Authorized Official
Title or Position	:	PROVIDER
Name	:	MELANIE RICHMOND PEARSON
Credential	:
Telephone Number	:	803-807-9533

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	04/10/2012

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