Organization Name:  PRO-MED 1 INC


Practice Location:
3489 LADSON RD SUITE B LADSON, SC 29456 US
Tel: 843-832-8397  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition	SC
N	332BX2000X	Suppliers Durable Medical Equipment & Medical Supplies	SC
N	335E00000X	Suppliers Prosthetic/Orthotic Supplier	SC
Y	332BC3200X	Suppliers Durable Medical Equipment & Medical Supplies	SC

Other Provider Identifiers:

Issuer	Number	State	Type
	DE1156	SC	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin