1184695017 NPI number — RELIABLE MEDICAL OF FLORENCE, LLC

Table of content: (NPI 1184695017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184695017 NPI number — RELIABLE MEDICAL OF FLORENCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE MEDICAL OF FLORENCE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184695017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108A THOMAS CARY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WANDO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29492-7940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-881-4928
Provider Business Mailing Address Fax Number:
843-884-8005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 KUKER ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29501-4376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-317-1068
Provider Business Practice Location Address Fax Number:
843-317-1688
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHEY
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
843-881-4928

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DE2655 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com