1922090539 NPI number — DR. MARIBEL RODRIGUEZ-SCOTT DO

Table of content: DR. MARIBEL RODRIGUEZ-SCOTT DO (NPI 1922090539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922090539 NPI number — DR. MARIBEL RODRIGUEZ-SCOTT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ-SCOTT
Provider First Name:
MARIBEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1922090539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2810 ASHLEY PHOSPHATE RD
Provider Second Line Business Mailing Address:
SUITE A-6
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29418-6405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-553-7744
Provider Business Mailing Address Fax Number:
843-553-7734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2810 ASHLEY PHOSPHATE RD
Provider Second Line Business Practice Location Address:
SUITE A-6
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29418-6405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-553-7744
Provider Business Practice Location Address Fax Number:
843-553-7734
Provider Enumeration Date:
08/19/2005

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: 207Q00000X , with the licence number:  1134 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 1134 , 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: JBM04730 . This is a "JUA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1134 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 42D1077950 . This is a "CLIA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP4815 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011347 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10167 . This is a "SC PCF" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 12706 . This is a "BROAD CERTIFICATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com