Provider Demographics
NPI:1528083318
Name:MOBILE MED LLC
Entity type:Organization
Organization Name:MOBILE MED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-675-1330
Mailing Address - Street 1:1247 S PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1344
Mailing Address - Country:US
Mailing Address - Phone:864-675-1330
Mailing Address - Fax:
Practice Address - Street 1:14 JOHN DAVENPORT DR NW STE 100
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4600
Practice Address - Country:US
Practice Address - Phone:706-235-0509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED EMPORIUM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511431717AMedicaid
5322660004Medicare NSC