1083601439 NPI number — FLOYD BRACE COMPANY, INC.

Table of content: (NPI 1083601439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083601439 NPI number — FLOYD BRACE COMPANY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLOYD BRACE COMPANY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083601439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9213 UNIVERSITY BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-9145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-614-6400
Provider Business Mailing Address Fax Number:
843-873-7387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9231 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-824-0625
Provider Business Practice Location Address Fax Number:
843-824-0127
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MAURICE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
843-824-0625

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DME779 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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