Provider Demographics
NPI:1932107075
Name:MED FOUR LLC
Entity Type:Organization
Organization Name:MED FOUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-370-3529
Mailing Address - Street 1:3555 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-2167
Mailing Address - Country:US
Mailing Address - Phone:864-370-3529
Mailing Address - Fax:864-370-3256
Practice Address - Street 1:3555 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2167
Practice Address - Country:US
Practice Address - Phone:864-370-3529
Practice Address - Fax:864-370-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-005844332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC751275Medicaid
SCDE1681Medicaid
SCDE1681Medicaid