Provider Demographics
NPI:1215155304
Name:PROFESSIONAL MEDICAL TRAINING AND SUPPLY
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL TRAINING AND SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGLOTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:843-346-9841
Mailing Address - Street 1:408 S KERSHAW ST
Mailing Address - Street 2:
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-1624
Mailing Address - Country:US
Mailing Address - Phone:843-346-9841
Mailing Address - Fax:775-855-0089
Practice Address - Street 1:408 S KERSHAW ST
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-1624
Practice Address - Country:US
Practice Address - Phone:843-346-9841
Practice Address - Fax:775-855-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies