Provider Demographics
NPI:1497803639
Name:MCR INC OF COLUMBIA
Entity Type:Organization
Organization Name:MCR INC OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-960-0952
Mailing Address - Street 1:209 LAURENT WAY
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9545
Mailing Address - Country:US
Mailing Address - Phone:803-960-0952
Mailing Address - Fax:803-832-7972
Practice Address - Street 1:209 LAURENT WAY
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9545
Practice Address - Country:US
Practice Address - Phone:803-960-0952
Practice Address - Fax:803-832-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier