Provider Demographics
NPI:1659384246
Name:FREE SPIRIT MOBILITY AND HOME MEDICAL
Entity Type:Organization
Organization Name:FREE SPIRIT MOBILITY AND HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST, CMA, CMOM
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARDRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-877-8566
Mailing Address - Street 1:107 A WEST WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-877-8566
Mailing Address - Fax:864-877-8807
Practice Address - Street 1:107A W WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1651
Practice Address - Country:US
Practice Address - Phone:864-877-8566
Practice Address - Fax:864-877-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2415Medicaid
SC5019370001Medicare ID - Type UnspecifiedPROVIDER ID