1255390993 NPI number — INTRAMED PLUS, LLC

Table of content: (NPI 1255390993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255390993 NPI number — INTRAMED PLUS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTRAMED PLUS, LLC
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:
6
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:
1255390993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 SALUDA RIDGE CT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29169-3455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-794-0200
Provider Business Mailing Address Fax Number:
803-794-1302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 SALUDA RIDGE CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-794-0200
Provider Business Practice Location Address Fax Number:
803-794-1302
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SETHNA
Authorized Official First Name:
MEENAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, CFO/TREASURER
Authorized Official Telephone Number:
800-679-6137

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  03224452600022043 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DME296 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60-01522 . This is a "CAROLINA CARE PLAN PROVID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 4219792 . This is a "NCPDP/NABP PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 726043 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20016931 . This is a "SELECT HEALTH PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 8511179 . This is a "AETNA INSURANCE PROVIDER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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