Organization
360 DURABLE MEDICAL SUPPLIES & EQUIPMENT
Active
Other names
360 DURABLE MEDICAL SUPPLIES & EQUIPMENT
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ANTHONY WALLACE (CEO)
(864) 625-3252
Entity
Organization
Contact information
Practice address
1314 N MAIN ST STE D, FOUNTAIN INN, SC 29644-1332
(864) 625-3252
Mailing address
1314 N MAIN ST STE D, FOUNTAIN INN, SC 29644-1332
(864) 625-3252
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/19/2020
Last updated
10/19/2020
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