1295759553 NPI number — HEALTH PHYSICIANS, PC

Table of content: (NPI 1295759553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295759553 NPI number — HEALTH PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH PHYSICIANS, 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:
TRICOUNTY SPINAL CARE 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:
1295759553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8626 DORCHESTER RD
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29420-7328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-225-7746
Provider Business Mailing Address Fax Number:
843-225-7749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8626 DORCHESTER RD
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29420-7328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-225-7746
Provider Business Practice Location Address Fax Number:
843-225-7749
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
CAMERON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
843-225-7746

Provider Taxonomy Codes

  • Taxonomy code: 111NX0100X , with the licence number:  2491 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 204C00000X , with the licence number: 021585 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: GCH462 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP4105 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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