Provider Demographics
NPI:1316424393
Name:MOBILE MEDICAL PC
Entity type:Organization
Organization Name:MOBILE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRTINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-410-0330
Mailing Address - Street 1:1991 GLENNS BAY RD UNIT 102B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-8614
Mailing Address - Country:US
Mailing Address - Phone:843-410-0330
Mailing Address - Fax:843-286-5384
Practice Address - Street 1:1991 GLENNS BAY RD STE 102B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575
Practice Address - Country:US
Practice Address - Phone:843-410-0330
Practice Address - Fax:843-286-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center