Provider Demographics
NPI:1154339828
Name:A-1 MEDICAL, INC
Entity type:Organization
Organization Name:A-1 MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-661-2166
Mailing Address - Street 1:1407 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6003
Mailing Address - Country:US
Mailing Address - Phone:843-661-2166
Mailing Address - Fax:843-679-5655
Practice Address - Street 1:1407 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6003
Practice Address - Country:US
Practice Address - Phone:843-661-2166
Practice Address - Fax:843-679-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC021307578332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1885Medicaid
SC5173240001Medicare NSC