1447382692 NPI number — ST JAMES HEALTH AND WELLNESS INC

Table of content: (NPI 1447382692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447382692 NPI number — ST JAMES HEALTH AND WELLNESS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JAMES HEALTH AND WELLNESS INC
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:
ST. JAMES-SANTEE FAMILY HEALTH CENTER, INC.
Provider Other Organization Name Type Code:
4
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:
1447382692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC CLELLANVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29458-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-887-3274
Provider Business Mailing Address Fax Number:
843-887-3929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8189 CHOPPEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29440-6374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-545-8723
Provider Business Practice Location Address Fax Number:
843-545-8346
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILLIARD
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
843-990-7993

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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