Provider Demographics
NPI:1639197668
Name:CAROLYN A MITCHELL
Entity Type:Organization
Organization Name:CAROLYN A MITCHELL
Other - Org Name:EXPRESS MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-662-2902
Mailing Address - Street 1:239B N MCQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2501
Mailing Address - Country:US
Mailing Address - Phone:843-662-2902
Mailing Address - Fax:843-662-6964
Practice Address - Street 1:239B N MCQUEEN 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:843-662-2902
Practice Address - Fax:843-662-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2548Medicaid
SC=========OtherTAX ID
SC=========OtherTAX ID