Healthcare Provider Details

I. General information

NPI: 1023331808
Provider Name (Legal Business Name): RESOURCE MEDICAL GROUP OF CHARLESTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 COMMERCE PL STE J
MYRTLE BEACH SC
29577-6550
US

IV. Provider business mailing address

4042 ASHLEY PHOSPHATE RD
N CHARLESTON SC
29418-8547
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-5101
  • Fax: 843-839-5103
Mailing address:
  • Phone: 843-767-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierDE3284
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: GREG CRAWFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 859-441-8876