Provider Demographics
NPI:1497770366
Name:MOBILE MED INC
Entity Type:Organization
Organization Name:MOBILE MED INC
Other - Org Name:LOWCOUNTRY HOME RESPIRTORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-569-0418
Mailing Address - Street 1:1247 SOUTH PLEASANTBURG DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605
Mailing Address - Country:US
Mailing Address - Phone:864-569-0418
Mailing Address - Fax:
Practice Address - Street 1:200 WEST 5TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-285-7903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1120Medicaid
SCDE1120Medicaid