Upstate Medical Supply LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

Legal business name

UPSTATE MEDICAL SUPPLY LLC

Practice address

408 N Duncan Byp Ste D&E
Union, SC 29379-8663

Phone

(864) 429-4507

Fax

(864) 429-4597

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Eric R Rohde

Title

Managing Member

Phone

(864) 429-4507

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1386677862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 N DUNCAN BYPASS",
            "address_2": "STE E-5 BOX 13",
            "city": "UNION",
            "state": "SC",
            "postal_code": "29379",
            "telephone_number": "864-429-4507",
            "fax_number": "864-429-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 N DUNCAN BYP STE D&E",
            "city": "UNION",
            "state": "SC",
            "postal_code": "293798663",
            "telephone_number": "864-429-4507",
            "fax_number": "864-429-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "ROHDE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "864-429-4507"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": "044063878",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE2751",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Union Medical Center (Union Medical Center-Professional Services)
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• Union Physicians Group LLC
• Upstate Lung & Critical Care Specialists, PC
• Upstate Lung and Critical Care Specialists PC
• Shannon Wade Vaughn, RN-BSN, CHPN
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0629)
• Wallace Thomson Hospital
• Wallace Thomson Hospital
• Wallace Thomson Hospital

• Oxygen Equipment & Supplies (DME) in Union, SC
• Providers in Union, SC by specialty
• Oxygen Equipment & Supplies (DME) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.