1619318896 NPI number — PRIORITY HEALTH

Table of content: (NPI 1619318896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619318896 NPI number — PRIORITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY HEALTH
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:
1619318896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 4177
Provider Second Line Business Mailing Address:
PRIORITY HEALTH, LLC
Provider Business Mailing Address City Name:
PAWLEYS ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-965-8482
Provider Business Mailing Address Fax Number:
888-242-0735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 WACHESAW ROAD
Provider Second Line Business Practice Location Address:
UNIT D
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-965-8482
Provider Business Practice Location Address Fax Number:
888-242-0735
Provider Enumeration Date:
07/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SALEEBY
Authorized Official First Name:
YUSEF
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
912-656-2297

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  SC21299 , 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)





Copyright © 2007-2024 www.npivalidator.com