Healthcare Provider Details

I. General information

NPI: 1710352331
Provider Name (Legal Business Name): PALMETTO OXYGEN OF THE MID-ATLANTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD SUITE 419
ALEXANDRIA VA
22306-3403
US

IV. Provider business mailing address

430 WOODRUFF ROAD SUITE 450
GREENVILLE SC
29607-3443
US

V. Phone/Fax

Practice location:
  • Phone: 703-436-4766
  • Fax:
Mailing address:
  • Phone: 864-272-1840
  • 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. MATTHEW S MELLOTT
Title or Position: PRESIDENT
Credential:
Phone: 864-272-1840