1013382290 NPI number — CJS MEDICAL SERVICES, PC

Table of content: (NPI 1013382290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013382290 NPI number — CJS MEDICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CJS MEDICAL SERVICES, PC
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:
6
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:
1013382290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
723 BAKER MILL LAKE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29053-8327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-926-0213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1455 HAGAN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-336-6436
Provider Business Practice Location Address Fax Number:
843-336-6836
Provider Enumeration Date:
12/14/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
803-926-0213

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  17688 , 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)