MEDICARE: MOBI CARE MEDICAL TRANSPORT, 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1942576244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBI CARE MEDICAL TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	2 OFFICE PARK CT
Second Line	:	SUITE 201
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5948
Country	:	US
Telephone Number	:	803-462-1381
Fax Number	:	877-821-9504

Provider Business Practice Location Address
First Line	:	2 OFFICE PARK CT
Second Line	:	SUITE 201
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5948
Country	:	US
Telephone Number	:	803-462-1381
Fax Number	:	877-821-9504

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JIM BURR
Credential	:
Telephone Number	:	803-462-1381

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	08/31/2012

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