Healthcare Provider Details

I. General information

NPI: 1659384246
Provider Name (Legal Business Name): FREE SPIRIT MOBILITY AND HOME MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107A W WADE HAMPTON BLVD
GREER SC
29650-1651
US

IV. Provider business mailing address

107 A WEST WADE HAMPTON BLVD
GREER SC
29650
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-8566
  • Fax: 864-877-8807
Mailing address:
  • Phone: 864-877-8566
  • Fax: 864-877-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDE2415
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MARIA A WARDRUP
Title or Position: BILLING SPECIALIST, CMA, CMOM
Credential:
Phone: 864-877-8566