Provider Demographics
NPI:1962434779
Name:PALMETTO MEDICAL EQUIPMENT OF FLORENCE
Entity type:Organization
Organization Name:PALMETTO MEDICAL EQUIPMENT OF FLORENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-629-8236
Mailing Address - Street 1:658 S COIT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5255
Mailing Address - Country:US
Mailing Address - Phone:843-629-8236
Mailing Address - Fax:843-629-8261
Practice Address - Street 1:658 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5255
Practice Address - Country:US
Practice Address - Phone:843-629-8236
Practice Address - Fax:843-629-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2686Medicaid
SCDE2686Medicaid