1093886103 NPI number — MS. CHARLENE RENAE BONE C.O.T.A.

Table of content: MS. CHARLENE RENAE BONE C.O.T.A. (NPI 1093886103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093886103 NPI number — MS. CHARLENE RENAE BONE C.O.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONE
Provider First Name:
CHARLENE
Provider Middle Name:
RENAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
C.O.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
CARLENE
Provider Other Middle Name:
RENAE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.O.T.A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093886103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 PARISH PARC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29485-8908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-532-8575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2880 TRICOM ST
Provider Second Line Business Practice Location Address:
SIUTE B
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-553-6343
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2006

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: 225XH1200X , with the licence number:  783A , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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