Individual
MRS. PAULA HICKS TARTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3679 HIGHWAY 57 S, FORK, SC 29543-6197
(843) 409-5524
Mailing address
3679 HIGHWAY 57 S, FORK, SC 29543-6197
(843) 409-5524
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
10/13/2009
Last updated
10/13/2009
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