1821286345 NPI number — DEVINE PSYCHIATRY LLC

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 1821286345 NPI number — DEVINE PSYCHIATRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVINE PSYCHIATRY LLC
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:
COLUMBIA PSYCHIATRIC ASSOCIATES
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:
1821286345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 TAYLOR ST
Provider Second Line Business Mailing Address:
SUITE 4-H
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-779-7500
Provider Business Mailing Address Fax Number:
803-779-7522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1333 TAYLOR ST
Provider Second Line Business Practice Location Address:
SUITE 4-H
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-779-7500
Provider Business Practice Location Address Fax Number:
803-779-7522
Provider Enumeration Date:
10/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VALENTIN
Authorized Official First Name:
MILAGROS
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
803-779-7500

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  23294 , 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: 232947 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA05688038 GRP #8038 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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