Provider Demographics
NPI: | 1952533515 |
---|---|
Name: | THE BALANCE MOBILITY & DIZZINESS CENTER |
Entity Type: | Organization |
Organization Name: | THE BALANCE MOBILITY & DIZZINESS CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | A/R SUPERVISOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WILMOT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 864-482-0064 |
Mailing Address - Street 1: | PO BOX 1844 |
Mailing Address - Street 2: | |
Mailing Address - City: | CLEMSON |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29633-1844 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-482-0064 |
Mailing Address - Fax: | 864-482-0081 |
Practice Address - Street 1: | 9241 UNIVERSITY BLVD STE B1 |
Practice Address - Street 2: | |
Practice Address - City: | N CHARLESTON |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29406-9349 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-764-4887 |
Practice Address - Fax: | 843-764-4509 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CLEMSON SPORTS MEDICINE AND REHAB INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2009-08-17 |
Last Update Date: | 2009-08-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |