Provider Demographics
NPI:1447259320
Name:WAB
Entity type:Organization
Organization Name:WAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-216-7000
Mailing Address - Street 1:1256 BEN SAWYER BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4578
Mailing Address - Country:US
Mailing Address - Phone:843-216-7000
Mailing Address - Fax:843-216-3600
Practice Address - Street 1:1256 BEN SAWYER BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4578
Practice Address - Country:US
Practice Address - Phone:843-216-7000
Practice Address - Fax:843-216-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1243Medicaid
SCDE1243Medicaid