1700125879 NPI number — EVER S COLLIER FNP

Table of content: EVER S COLLIER FNP (NPI 1700125879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700125879 NPI number — EVER S COLLIER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLIER
Provider First Name:
EVER
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1700125879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29230-3788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-733-5969
Provider Business Mailing Address Fax Number:
803-217-0026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 CLARKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTOVER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29044-8769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-353-8741
Provider Business Practice Location Address Fax Number:
803-353-8789
Provider Enumeration Date:
02/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  201302 , 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)

  • Identifier: FQC031 . This is a "MEDICAID FQC31" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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