Provider Demographics
NPI:1538568340
Name:360 MEDICAL
Entity type:Organization
Organization Name:360 MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-606-3500
Mailing Address - Street 1:1011 LAKE HUNTER CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5418
Mailing Address - Country:US
Mailing Address - Phone:843-606-3500
Mailing Address - Fax:843-737-8190
Practice Address - Street 1:1011 LAKE HUNTER CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5418
Practice Address - Country:US
Practice Address - Phone:843-606-3500
Practice Address - Fax:843-737-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier