1447420070 NPI number — ROCK HILL DERMATOLOGY CENTER

Table of content: (NPI 1447420070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447420070 NPI number — ROCK HILL DERMATOLOGY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCK HILL DERMATOLOGY CENTER
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:
1447420070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1533 EBENEZER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29732-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-328-1831
Provider Business Mailing Address Fax Number:
803-324-5131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1533 EBENEZER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-328-1831
Provider Business Practice Location Address Fax Number:
803-328-0283
Provider Enumeration Date:
03/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IDLIBI
Authorized Official First Name:
OZ
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
803-393-3710

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  06954 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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