MEDICARE: MR. ROBERT EDWARD MCGOWENS III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		SC

General Provider Information

NPI Number	:	1396616173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EDWARD MCGOWENS III

Provider Business Mailing Address
First Line	:	451 HAYWOOD RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 HAYWOOD RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4304
Country	:	US
Telephone Number	:	864-619-1532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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