MEDICARE: TRINITY MEDICAL SUPPLY OF AIKEN,SC

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	3897260001	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	:	1417179680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY MEDICAL SUPPLY OF AIKEN,SC

Provider Business Mailing Address
First Line	:	4360 AUGUSTA RD # S-H189
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7491
Country	:	US
Telephone Number	:	803-739-8987
Fax Number	:	803-739-8907

Provider Business Practice Location Address
First Line	:	2316 SUNSET BLVD STE D
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-4772
Country	:	US
Telephone Number	:	803-739-8987
Fax Number	:	803-739-8987

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BEVERLY LARRAINE TUCKER
Credential	:
Telephone Number	:	803-739-8987

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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