1366627325 NPI number — MS. STEFANI S REDDING

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 1366627325 NPI number — MS. STEFANI S REDDING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDING
Provider First Name:
STEFANI
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDDING
Provider Other First Name:
STEFANI
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366627325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7295 HIGHWAY 184 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DONALDS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29638-8881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-223-8331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1547 PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29646-4081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-223-8331
Provider Business Practice Location Address Fax Number:
864-223-3706
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 421504 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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