Provider Demographics
NPI:1851005250
Name:ADVANCED MOBILCARE
Entity Type:Organization
Organization Name:ADVANCED MOBILCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-522-2077
Mailing Address - Street 1:41 GREEN ASH CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7618
Mailing Address - Country:US
Mailing Address - Phone:803-522-2077
Mailing Address - Fax:803-626-0622
Practice Address - Street 1:401 WESTERN LN
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7953
Practice Address - Country:US
Practice Address - Phone:866-996-2126
Practice Address - Fax:803-626-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)