Provider Demographics
NPI:1437972700
Name:OWENS, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ROBERSON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-6162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:843-627-3051
Practice Address - Street 1:135 ROBERSON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-6162
Practice Address - Country:US
Practice Address - Phone:843-627-3042
Practice Address - Fax:843-627-3051
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)