1952684433 NPI number — COX SPEECH-LANGUAGE PATHOLOGY, INC.

Table of content: (NPI 1952684433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952684433 NPI number — COX SPEECH-LANGUAGE PATHOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COX SPEECH-LANGUAGE PATHOLOGY, INC.
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:
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:
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NPI Number Information

NPI Number:
1952684433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2323 HIGHWAY 41 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE VIEW
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29563-5590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-759-0205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 N MAULDIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATTA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29565-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-713-1677
Provider Business Practice Location Address Fax Number:
843-418-3011
Provider Enumeration Date:
09/21/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CEO/SLP
Authorized Official Telephone Number:
843-759-0205

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3975 , 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: 1689817629 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SA0972 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".