1043296700 NPI number — AIKEN EMERGENCY PHYSICIANS, PA

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 1043296700 NPI number — AIKEN EMERGENCY PHYSICIANS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIKEN EMERGENCY PHYSICIANS, PA
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:
1043296700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/03/2023
NPI Reactivation Date:
05/25/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 EDGEFIELD AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29801-3910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-648-4224
Provider Business Mailing Address Fax Number:
803-641-7600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 EDGEFIELD AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29801-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-648-4224
Provider Business Practice Location Address Fax Number:
803-641-7600
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FINDLEY
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
803-648-4224

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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)

  • Identifier: PA4502 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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