Provider Demographics
NPI:1902947872
Name:MOBILE MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:MOBILE MEDICAL CARE, INC.
Other - Org Name:SHEPHERD CARE HOSPICE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:TILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:843-526-1186
Mailing Address - Street 1:P.O. BOX 392
Mailing Address - Street 2:
Mailing Address - City:NICHOLS
Mailing Address - State:SC
Mailing Address - Zip Code:29581-0392
Mailing Address - Country:US
Mailing Address - Phone:843-526-1186
Mailing Address - Fax:843-526-1389
Practice Address - Street 1:210 SOUTH NICHOLS STREET
Practice Address - Street 2:
Practice Address - City:NICHOLS
Practice Address - State:SC
Practice Address - Zip Code:29581-0392
Practice Address - Country:US
Practice Address - Phone:843-526-1186
Practice Address - Fax:843-526-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC104251G00000X
SCHPC-104251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP082Medicaid
SC1902947872OtherNPI
SCHSP082Medicaid