1013200948 NPI number — MEDACLAIM

Table of content: (NPI 1013200948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013200948 NPI number — MEDACLAIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDACLAIM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDECLAIM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013200948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2259 RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29650-4507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-250-2099
Provider Business Mailing Address Fax Number:
864-312-5953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 WADE HAMPTON BLVD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29609-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-250-2099
Provider Business Practice Location Address Fax Number:
864-250-0595
Provider Enumeration Date:
05/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GILLIAM
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
864-205-2099

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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