Provider Demographics
NPI:1457335283
Name:AFFORDABLE MEDICAL & MOBILITY EQUIPMENT, LLC
Entity Type:Organization
Organization Name:AFFORDABLE MEDICAL & MOBILITY EQUIPMENT, LLC
Other - Org Name:AFFORDABLE MOBILITY EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-926-1493
Mailing Address - Street 1:1538 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5918
Mailing Address - Country:US
Mailing Address - Phone:803-926-1493
Mailing Address - Fax:803-926-1494
Practice Address - Street 1:1538 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5918
Practice Address - Country:US
Practice Address - Phone:803-926-1493
Practice Address - Fax:803-926-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
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
SCDE2636Medicaid
SCDE2636Medicaid