Provider Demographics
NPI:1871586974
Name:BAMBERG MEDICAL EQUIPMENT & SUPPLY
Entity type:Organization
Organization Name:BAMBERG MEDICAL EQUIPMENT & SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-245-1708
Mailing Address - Street 1:510 RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4312
Mailing Address - Country:US
Mailing Address - Phone:803-425-7352
Mailing Address - Fax:803-713-1414
Practice Address - Street 1:3109 MAIN HWY
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1614
Practice Address - Country:US
Practice Address - Phone:803-245-1708
Practice Address - Fax:803-245-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65006621332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2143Medicaid
SC4545900001Medicare NSC