1073014247 NPI number — WORKERS COMP CONSULTING SERVICES LLC

Table of content: DR. ANN M. HETZEL PH.D. (NPI 1922327105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073014247 NPI number — WORKERS COMP CONSULTING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORKERS COMP CONSULTING SERVICES 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:
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:
1073014247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 290428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29229-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4611 HARD SCRABBLE RD STE 109-101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29229-8584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-999-6570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
PATTY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL PARTNER
Authorized Official Telephone Number:
803-999-6570

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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