MEDICARE: MID-SOUTH HOME CARE SERVICES, LLC

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1356109102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-SOUTH HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4060
Second Line	:	ATTN: REGULATORY
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	4975 LACROSS RD STE 200A-A
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-6523
Country	:	US
Telephone Number	:	854-214-2057
Fax Number	:	854-214-2321

Authorized Official
Title or Position	:	VP OF LICENSURE
Name	:	JANET COMBS
Credential	:
Telephone Number	:	704-664-2876

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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