BI-LO, LLC. (BI-LO PHARMACY #5105) - NPI NUMBER 1750474110

Summary

Provider Name: BI-LO, LLC. (BI-LO PHARMACY #5105)

NPI Number: 1750474110

Clasification: Durable Medical Equipment & Medical Supplies (332B00000X)

Address:
720 MAIN ST
NORTH MYRTLE BEACH, SC
ZIP 29582

Phone Number: (843) 249-8553



Detailed Information

BI-LO, LLC. is a durable medical equipment & medical supplies in North Myrtle Beach, SC. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient�s use in the home and that are usable for an extended period of time. The assigned NPI number for this provider is 1750474110 and is registered as an organization entity type.
The provider Is Doing Business As Bi-lo Pharmacy #5105.

The provider's business address is:

720 MAIN ST
NORTH MYRTLE BEACH, SC
ZIP 29582-030
Phone: (843) 249-8553
Fax: (843) 249-4794

The provider's authorized official is M. Sandlin Grimm .
The authorized official title is Secretary and has the following contact phone number (904) 783-5578.

The enumeration date for this NPI number is 9/30/2006 and was last updated on 6/28/2013.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1083697890 MEDICAL SERVICES OF AMERICA INC
Durable Medical Equipment & Medical Supplies
1124045398 WAL-MART STORES EAST LP
Durable Medical Equipment & Medical Supplies
1194818559 BI-LO, LLC.
Durable Medical Equipment & Medical Supplies
1225088974 RUONALA DURABLE MEDICAL EQUIPMENT INC.
Durable Medical Equipment & Medical Supplies
1255434791 SOUTH CAROLINA CVS PHARMACY LLC
Durable Medical Equipment & Medical Supplies
1063727691 EXPERT HOME MEDICAL. LLC
Durable Medical Equipment & Medical Supplies (Oxygen Equipment & Supplies)
1093835423 COASTAL HOME CARE
Durable Medical Equipment & Medical Supplies (Parenteral & Enteral Nutrition)

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 332B00000X Durable Medical Equipment & Medical Supplies 14445 SC No
2 3336C0003X Pharmacy Community/Retail Pharmacy Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 4222472 OTHER OTHER ID NUMBER-COMMERCIAL NUMBER
2 3866820042 MEDICARE NSC SC
3 714445 MEDICAID SC
4 781534 MEDICAID SC
5 DE2092 OTHER SC MEDICAID DME

NPI Record

No. Field Name Field Value
1 NPI 1750474110
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name BI-LO, LLC.
5 Provider Other Organization Name BI-LO PHARMACY #5105
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 720 MAIN ST
8 Provider Business Practice Location Address City Name NORTH MYRTLE BEACH
9 Provider Business Practice Location Address State Name SC
10 Provider Business Practice Location Address Postal Code 295823030
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 8432498553
13 Provider Business Practice Location Address Fax Number 8432494794
14 Provider Enumeration Date 9/30/2006
15 Last Update Date 6/28/2013
16 Authorized Official Last Name GRIMM
17 Authorized Official First Name M. SANDLIN
18 Authorized Official Title or Position SECRETARY
19 Authorized Official Telephone Number 9047835578
20 Healthcare Provider Taxonomy Code 1 332B00000X
21 Provider License Number 1 14445
22 Provider License Number State Code 1 SC
23 Healthcare Provider Primary Taxonomy Switch 1 N
24 Healthcare Provider Taxonomy Code 2 3336C0003X
25 Healthcare Provider Primary Taxonomy Switch 2 Y
26 Other Provider Identifier 1 4222472
27 Other Provider Identifier Type Code 1 01
28 Other Provider Identifier Issuer 1 OTHER ID NUMBER-COMMERCIAL NUMBER
29 Other Provider Identifier 2 3866820042
30 Other Provider Identifier Type Code 2 07
31 Other Provider Identifier State 2 SC
32 Other Provider Identifier 3 714445
33 Other Provider Identifier Type Code 3 05
34 Other Provider Identifier State 3 SC
35 Other Provider Identifier 4 781534
36 Other Provider Identifier Type Code 4 05
37 Other Provider Identifier State 4 SC
38 Other Provider Identifier 5 DE2092
39 Other Provider Identifier Type Code 5 01
40 Other Provider Identifier State 5 SC
41 Other Provider Identifier Issuer 5 MEDICAID DME
42 Is Organization Subpart Y
43 Parent Organization LBN BI-LO, LLC.
44 Parent Organization TIN

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.