1508899964 NPI number — MEDICAL ESSENTIALS LLC

Table of content: (NPI 1508899964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508899964 NPI number — MEDICAL ESSENTIALS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ESSENTIALS 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:
1508899964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 PELHAM RD STE B211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29615-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-234-1438
Provider Business Mailing Address Fax Number:
864-234-1408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29681-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-757-1467
Provider Business Practice Location Address Fax Number:
864-757-1469
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WELBAUM
Authorized Official First Name:
MARY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
864-234-1438

Provider Taxonomy Codes

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

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

  • Identifier: DE2650 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com