Provider Demographics
NPI:1003932633
Name:ANTHONY L MATHIS DPM LLC
Entity Type:Organization
Organization Name:ANTHONY L MATHIS DPM LLC
Other - Org Name:MD MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-483-2186
Mailing Address - Street 1:127 MILLS AVE
Mailing Address - Street 2:STE A
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-2514
Mailing Address - Country:US
Mailing Address - Phone:864-483-2186
Mailing Address - Fax:864-801-9056
Practice Address - Street 1:127 MILLS AVE STE A
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-2514
Practice Address - Country:US
Practice Address - Phone:864-483-2186
Practice Address - Fax:864-801-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2742Medicaid
SCDE2742Medicaid