MEDICARE: MOBILE HEALTHCARE, INC

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	332B00000X	Durable Medical Equipment & Medical Supplies		SC

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

General Provider Information

NPI Number	:	1720087026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	622 WADE HAMPTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29609-4968
Country	:	US
Telephone Number	:	864-370-9773
Fax Number	:	864-370-0374

Provider Business Practice Location Address
First Line	:	622 WADE HAMPTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29609-4968
Country	:	US
Telephone Number	:	864-370-9773
Fax Number	:	864-370-0374

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	S BRYANT MCCLAIN
Credential	:
Telephone Number	:	864-370-9773

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/21/2022

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