1821238551 NPI number — MEDICAL UNIVERSITY HOSPITAL AUTHORITY

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 1821238551 NPI number — MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
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:
MUSC ASHLEY RIVER TOWER PHARMACY
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:
1821238551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 ASHLEY AVE
Provider Second Line Business Mailing Address:
MSC 584
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29425-8907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-792-1009
Provider Business Mailing Address Fax Number:
843-792-0566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 COURTENAY DR
Provider Second Line Business Practice Location Address:
RM M104
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-8911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-876-0199
Provider Business Practice Location Address Fax Number:
843-876-4583
Provider Enumeration Date:
02/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
843-792-8775

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 9750 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 797506 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2119087 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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