1265498166 NPI number — UNIVERSITY OF SOUTH CAROLINA SYSTEM

Table of content: (NPI 1265498166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265498166 NPI number — UNIVERSITY OF SOUTH CAROLINA SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTH CAROLINA SYSTEM
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:
UNIVERSITY HEALTH SERVICES JOHN MORRISON WHITE CLINIC
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:
1265498166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 889
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-313-7011
Provider Business Mailing Address Fax Number:
803-313-7438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 HUBBARD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-313-7011
Provider Business Practice Location Address Fax Number:
803-313-7438
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RINER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DIRECTOR HEALTH SERVICES
Authorized Official Telephone Number:
803-313-7012

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GP3450 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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