Individual ProviderEthan MosleyStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice AddressGrand Strand Medical Center- Gme Office, 809 82nd Pkwy, Myrtle Beach, SC 29572(843) 692-1595PECOS EnrollmentBased on the most recent information from CMS, provider Ethan Mosley is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records today at 11:05 AM.Profile DetailsProvider ID1033790126Provider TypeIndividualFull NameMosley, EthanCredentialDOGenderMaleSole ProprietorNoEnumeration Date4/20/2021Last Updated4/20/2021Contact InformationPractice LocationPractice AddressGrand Strand Medical Center- Gme Office, 809 82nd Pkwy, Myrtle Beach, SC 29572Phone(843) 692-1595Fax(843) 692-1122Mailing LocationMailing AddressGrand Strand Medical Center- Gme Office, 809 82nd Pkwy, Myrtle Beach, SC 29572Phone(843) 692-1595Fax(843) 692-1122Provider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer