Healthcare Provider Details

I. General information

NPI: 1497770366
Provider Name (Legal Business Name): MOBILE MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST 5TH STREET NORTH
SUMMERVILLE SC
29483
US

IV. Provider business mailing address

1247 SOUTH PLEASANTBURG DRIVE
GREENVILLE SC
29605
US

V. Phone/Fax

Practice location:
  • Phone: 843-285-7903
  • Fax:
Mailing address:
  • Phone: 864-569-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DOUG TRENOR
Title or Position: PRESIDENT
Credential:
Phone: 864-569-0418