Healthcare Provider Details

I. General information

NPI: 1316424393
Provider Name (Legal Business Name): MOBILE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 GLENNS BAY RD STE 102B
MYRTLE BEACH SC
29575
US

IV. Provider business mailing address

1991 GLENNS BAY RD UNIT 102B
MYRTLE BEACH SC
29575-8614
US

V. Phone/Fax

Practice location:
  • Phone: 843-410-0330
  • Fax: 843-286-5384
Mailing address:
  • Phone: 843-410-0330
  • Fax: 843-286-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRTINEY REED
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 843-410-0330