Provider Demographics
NPI:1699094664
Name:ESSEX MEDICAL SUPPLY
Entity type:Organization
Organization Name:ESSEX MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-837-3758
Mailing Address - Street 1:20 TOWNE DR
Mailing Address - Street 2:SUITE 246
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4204
Mailing Address - Country:US
Mailing Address - Phone:843-837-3758
Mailing Address - Fax:866-936-8405
Practice Address - Street 1:20 TOWNE DR
Practice Address - Street 2:SUITE 246
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4204
Practice Address - Country:US
Practice Address - Phone:843-837-3758
Practice Address - Fax:866-936-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
SCAK2734335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier