MEDICARE: MED FOUR LLC

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	50-005844	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932107075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED FOUR LLC

Provider Business Mailing Address
First Line	:	3555 RUTHERFORD RD
Second Line	:
City	:	TAYLORS
State	:	SC
Zip	:	29687-2167
Country	:	US
Telephone Number	:	864-370-3529
Fax Number	:	864-370-3256

Provider Business Practice Location Address
First Line	:	3555 RUTHERFORD RD
Second Line	:
City	:	TAYLORS
State	:	SC
Zip	:	29687-2167
Country	:	US
Telephone Number	:	864-370-3529
Fax Number	:	864-370-3256

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES THOMPSON
Credential	:
Telephone Number	:	864-370-3529

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/22/2020

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Directions to “MED FOUR LLC ” Practice Location

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