Prestige Diabetic Supplies

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PRESTIGE DIABETIC SUPPLIES

Practice address

6 Executive CT
Lake Wylie, SC 29710-9338

Phone

(803) 831-6778

NPI assigned

Jul 10, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Edward Perry Jackson

Title

Partner

Phone

(803) 831-6778

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247184000000",
    "number": "1285863324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE CT",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297109338",
            "telephone_number": "803-831-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE CT",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297109338",
            "telephone_number": "803-831-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE DIABETIC SUPPLIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-10",
        "last_updated": "2009-07-10",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "PERRY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "803-831-6778",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Lake Wylie, SC
• Providers in Lake Wylie, SC by specialty
• Durable Medical Equipment & Medical Supplies in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.