Provider Demographics
NPI:1386321362
Name:PRESTIGIOUS DURAMED AND INCONTINENCE SUPPLIES, LLC
Entity type:Organization
Organization Name:PRESTIGIOUS DURAMED AND INCONTINENCE SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINASTI
Authorized Official - Middle Name:NAZAIYH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-479-0020
Mailing Address - Street 1:1306 W POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1250
Mailing Address - Country:US
Mailing Address - Phone:864-373-8953
Mailing Address - Fax:
Practice Address - Street 1:1306 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1250
Practice Address - Country:US
Practice Address - Phone:864-373-8953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies