Healthcare Provider Details

I. General information

NPI: 1669617916
Provider Name (Legal Business Name): CAROLINA MOBILITY & SEATING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 INDEPENDENCE PKWY STE 400
CHESAPEAKE VA
23320-5212
US

IV. Provider business mailing address

644 INDEPENDENCE PKWY STE 400
CHESAPEAKE VA
23320-5212
US

V. Phone/Fax

Practice location:
  • Phone: 757-966-7964
  • Fax:
Mailing address:
  • Phone: 757-966-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0206009258
License Number StateVA

VIII. Authorized Official

Name: MELICK B ELLIOTT
Title or Position: PRESIDENT OWNER
Credential:
Phone: 919-303-0902