MEDICARE: MOBILE MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1316424393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE MEDICAL PC

Provider Business Mailing Address
First Line	:	1991 GLENNS BAY RD UNIT 102B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-8614
Country	:	US
Telephone Number	:	843-410-0330
Fax Number	:	843-286-5384

Provider Business Practice Location Address
First Line	:	1991 GLENNS BAY RD STE 102B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575
Country	:	US
Telephone Number	:	843-410-0330
Fax Number	:	843-286-5384

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	BRTINEY REED
Credential	:
Telephone Number	:	843-410-0330

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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Directions to “MOBILE MEDICAL PC ” Practice Location

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