MEDICARE: PERFORMANCE MEDICAL SUPPLY 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1851597488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	622 OLD TROLLEY RD
Second Line	:	SUITE 126
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-5674
Country	:	US
Telephone Number	:	843-486-5274
Fax Number	:	843-486-5279

Provider Business Practice Location Address
First Line	:	622 OLD TROLLEY RD
Second Line	:	SUITE 126
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-5674
Country	:	US
Telephone Number	:	843-486-5274
Fax Number	:	843-486-5279

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEVIN M HESTER
Credential	:
Telephone Number	:	803-791-5904

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	05/07/2008

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