Provider Demographics
NPI:1710352331
Name:PALMETTO OXYGEN OF THE MID-ATLANTIC, LLC
Entity Type:Organization
Organization Name:PALMETTO OXYGEN OF THE MID-ATLANTIC, LLC
Other - Org Name:MEDBRIDGE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-272-1840
Mailing Address - Street 1:430 WOODRUFF ROAD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3443
Mailing Address - Country:US
Mailing Address - Phone:864-272-1840
Mailing Address - Fax:
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 419
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-436-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDBRIDGE HOME MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-08
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies