1487715819 NPI number — UNION HOSPITAL DISTRICT

Table of content: (NPI 1487715819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487715819 NPI number — UNION HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION HOSPITAL DISTRICT
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:
CHA UPSTATE PEDIATRICS
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:
1487715819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 S DUNCAN BYP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29379-7830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-427-4081
Provider Business Mailing Address Fax Number:
864-427-8733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 W. SOUTH ST. STE. C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29379-2771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-429-8846
Provider Business Practice Location Address Fax Number:
864-429-9093
Provider Enumeration Date:
12/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PETTIT
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHA DIRECTOR PHYSICIAN SERVICES
Authorized Official Telephone Number:
864-427-0331

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RHC144 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".