1619022662 NPI number — S.F. WORSHAM MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619022662 NPI number — S.F. WORSHAM MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.F. WORSHAM MD PA
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:
S.F. WORSHAM MD PA FAMILY PRACTICE
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:
1619022662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 BUFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-224-1316
Provider Business Mailing Address Fax Number:
864-224-5068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 BUFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-224-1316
Provider Business Practice Location Address Fax Number:
864-224-5068
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WORSHAM
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
FORD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-224-1316

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  16215 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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