1063713451 NPI number — UNIVERSITY OF SOUTH CAROLINA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063713451 NPI number — UNIVERSITY OF SOUTH CAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTH CAROLINA
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:
Provider Other Organization Name Type Code:
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:
1063713451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CENTER FOR DISABILITY RESOURCES, PEDIATRICS
Provider Second Line Business Mailing Address:
SCHOOL OF MEDICINE, UNIVERSITY OF SOUTH CAROLINA
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29208-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-434-7950
Provider Business Mailing Address Fax Number:
803-434-8606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8301 FARROW ROAD
Provider Second Line Business Practice Location Address:
COLLABORATIVE BUILDING A
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-3245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-7950
Provider Business Practice Location Address Fax Number:
803-434-8606
Provider Enumeration Date:
11/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF BUSINESS OFFICER
Authorized Official Telephone Number:
803-733-3213

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1-09-5360 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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