MEDICARE: MICHAEL R. TAMBLING

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	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C814	OTHER	SC	ANCILLARY CARE MANAGEMENT

General Provider Information

NPI Number	:	1396803409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL R. TAMBLING

Provider Business Mailing Address
First Line	:	1671 LAKE MURRAY BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8626
Country	:	US
Telephone Number	:	803-269-3990
Fax Number	:	803-407-9195

Provider Business Practice Location Address
First Line	:	1671 LAKE MURRAY BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8626
Country	:	US
Telephone Number	:	803-269-3990
Fax Number	:	803-407-9195

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. RICHARD G GRAHAM
Credential	:	C.PED, O.S.T.
Telephone Number	:	803-269-3990

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	12/29/2008

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