1093705121 NPI number — KERSHAW HOSPITAL LLC

Table of content: KEITH ROBERT FOSTER DMD (NPI 1780352260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093705121 NPI number — KERSHAW HOSPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERSHAW HOSPITAL LLC
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:
KERSHAWHEALTH HOME HEALTH
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:
1093705121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1165 HIGHWAY 1 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUGOFF
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29078-8966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-425-1182
Provider Business Mailing Address Fax Number:
803-432-6351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1165 HIGHWAY 1 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUGOFF
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29078-8966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-425-1182
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
ASSISTANT VICE PRESIDENT, SECRETARY
Authorized Official Telephone Number:
615-920-7000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA-0321 , 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: 470467 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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