Basic Information
| Provider Information | |||||||||
| NPI: | 1669617916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA MOBILITY & SEATING, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 644 INDEPENDENCE PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233205212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579667964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 644 INDEPENDENCE PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233205212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579667964 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2008 | ||||||||
| LastUpdateDate: | 08/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | ELLIOTT | ||||||||
| AuthorizedOfficialFirstName: | MELICK | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9193030902 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 0206009258 | VA | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 183834 | 01 | VA | ANTHEM BCBS | OTHER | 10080924 | 05 | VA | MEDICAID | 10001676 | 01 | VA | OPTIMA | OTHER |