Provider Demographics
NPI:1326373010
Name:HEART OF THE CAROLINAS MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:HEART OF THE CAROLINAS MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:864-990-4345
Mailing Address - Street 1:511 WEST BUTLER ROAD SUITE E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4890
Mailing Address - Country:US
Mailing Address - Phone:864-990-4345
Mailing Address - Fax:864-751-4201
Practice Address - Street 1:511 WEST BUTLER ROAD SUITE E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4890
Practice Address - Country:US
Practice Address - Phone:864-990-4345
Practice Address - Fax:864-751-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCEN2056251J00000X
332B00000X
SCDE3254332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEN2056Medicaid