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General NPI Number Information
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NPI Number | 1932107075
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Entity Type | Organization
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Legal Business Name | MED FOUR LLC
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3555 RUTHERFORD RD
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City | TAYLORS
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State | SC
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Zip | 29687-2167
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Country | US
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Telephone | 864-370-3529
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Fax | 864-370-3256
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Provider Business Mailing Address
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Address Line | 3555 RUTHERFORD RD
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City | TAYLORS
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State | SC
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Zip | 29687-2167
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Country | US
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Telephone | 864-370-3529
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Fax | 864-370-3256
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES THOMPSON
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Credential |
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Telephone | 864-370-3529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 50-005844
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License Number State | SC
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