Provider Demographics
NPI:1063461275
Name:TKT & ASSOCIATES D/B/A CAROLINA MOBILITY CENTER
Entity Type:Organization
Organization Name:TKT & ASSOCIATES D/B/A CAROLINA MOBILITY CENTER
Other - Org Name:CAROLINA MOBILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-665-5678
Mailing Address - Street 1:P.O. BOX 808
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-0808
Mailing Address - Country:US
Mailing Address - Phone:843-665-5678
Mailing Address - Fax:843-669-8842
Practice Address - Street 1:1209 W. EVANS STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-665-5678
Practice Address - Fax:843-669-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2228Medicaid
SC462536001Medicare UPIN
SC4625360001Medicare ID - Type Unspecified