1942293857 NPI number — DR. BEULAH M. BROOKS DPM

Table of content: MARCEE WHITE (NPI 1427191006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942293857 NPI number — DR. BEULAH M. BROOKS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
BEULAH
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1942293857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1633
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTERBORO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29488-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-549-6271
Provider Business Mailing Address Fax Number:
843-542-9030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29403-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-722-8628
Provider Business Practice Location Address Fax Number:
843-722-1055
Provider Enumeration Date:
08/25/2005

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: 213E00000X , with the licence number:  123 , 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: 84899 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 9638584 . This is a "GHI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DE1790 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: S346000 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 480015086 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P00374130 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: PD1233 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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