1053716050 NPI number — ANNSLEY MARIE TROXELL PA-C

Table of content: ANNSLEY MARIE TROXELL PA-C (NPI 1053716050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053716050 NPI number — ANNSLEY MARIE TROXELL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROXELL
Provider First Name:
ANNSLEY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1053716050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 RIBAUT RD
Provider Second Line Business Mailing Address:
BMAC CREDENTIALING COORDINATOR
Provider Business Mailing Address City Name:
PORT ROYAL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29902-5441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-524-8171
Provider Business Mailing Address Fax Number:
844-296-2307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BEAUFORT MEMORIAL SURGICAL SPECIALISTS
Provider Second Line Business Practice Location Address:
1680 RIBAUT RD
Provider Business Practice Location Address City Name:
PORT ROYAL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29935-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-524-2307
Provider Business Practice Location Address Fax Number:
844-296-2307
Provider Enumeration Date:
11/03/2014

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: 363A00000X , with the licence number:  2215 , 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: 2522PA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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