Provider Demographics
NPI:1023331808
Name:RESOURCE MEDICAL GROUP OF CHARLESTON, LLC
Entity type:Organization
Organization Name:RESOURCE MEDICAL GROUP OF CHARLESTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-8876
Mailing Address - Street 1:4042 ASHLEY PHOSPHATE RD
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8547
Mailing Address - Country:US
Mailing Address - Phone:843-767-3344
Mailing Address - Fax:
Practice Address - Street 1:1406 COMMERCE PL
Practice Address - Street 2:STE J
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6550
Practice Address - Country:US
Practice Address - Phone:843-839-5101
Practice Address - Fax:843-839-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3284Medicaid
SC5755040002Medicare NSC