Provider Demographics
NPI:1598356651
Name:MAJOR MEDICAL SUPPLY AND HEALTHCARE SERVICES
Entity type:Organization
Organization Name:MAJOR MEDICAL SUPPLY AND HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-988-7360
Mailing Address - Street 1:640 OLD AIRPORT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-5034
Mailing Address - Country:US
Mailing Address - Phone:803-998-7360
Mailing Address - Fax:803-226-0482
Practice Address - Street 1:107 CHARLESTON ROW BLVD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6590
Practice Address - Country:US
Practice Address - Phone:803-998-7360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC008505486OtherDRIVER'S LICENSE