Healthcare Provider Details

I. General information

NPI: 1518251271
Provider Name (Legal Business Name): MY SPECIAL WORLD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 05/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 TILLOTSON RD
ANDERSON SC
29621-5105
US

IV. Provider business mailing address

780 TILLOTSON RD
ANDERSON SC
29621-5105
US

V. Phone/Fax

Practice location:
  • Phone: 864-353-1499
  • Fax: 864-296-6910
Mailing address:
  • Phone: 864-353-1499
  • Fax: 864-296-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. HERBERT M MITCHELL
Title or Position: OWNER
Credential:
Phone: 864-353-1499