1184637902 NPI number — AMERICARE HEALTH, PC

Table of content: (NPI 1184637902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184637902 NPI number — AMERICARE HEALTH, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICARE HEALTH, 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:
FAMILY MEDICAL CENTER
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:
1184637902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 N PEARL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAGELAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29728-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-672-3100
Provider Business Mailing Address Fax Number:
843-672-3102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 N PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAGELAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29728-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-672-3100
Provider Business Practice Location Address Fax Number:
843-672-3102
Provider Enumeration Date:
08/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EDOSOMWAN
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
ABIMBOLA
Authorized Official Title or Position:
FINANCIAL CONTROLLER
Authorized Official Telephone Number:
704-535-0400

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002G . This is a "PROVIDER ID#" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SC-GP1785 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NC790515T , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".