Provider Demographics
NPI:1972618114
Name:PC INDUSTRIES INC
Entity Type:Organization
Organization Name:PC INDUSTRIES INC
Other - Org Name:MOBILITY CENTER OF VA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:O
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-231-7774
Mailing Address - Street 1:249-255 E GERMAN SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-1460
Mailing Address - Country:US
Mailing Address - Phone:804-231-7774
Mailing Address - Fax:804-231-0179
Practice Address - Street 1:249-255 E GERMAN SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1460
Practice Address - Country:US
Practice Address - Phone:804-231-7774
Practice Address - Fax:804-231-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009119906Medicaid
VA009119906Medicaid