Provider Demographics
NPI:1285659151
Name:MOBILE MED INC
Entity Type:Organization
Organization Name:MOBILE MED INC
Other - Org Name:BREATHE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BESON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:843-285-7903
Mailing Address - Street 1:200 WEST 5TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483
Mailing Address - Country:US
Mailing Address - Phone:843-285-7903
Mailing Address - Fax:
Practice Address - Street 1:114 S CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2406
Practice Address - Country:US
Practice Address - Phone:502-896-8335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50009464Medicaid
KY90011461Medicaid
KY370765OtherANTHEM BCBS
5322660001Medicare ID - Type Unspecified