1144890427 NPI number — MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Table of content: STEPHANY ALEXANDRA CARTAGENA PONCIANO LGPC (NPI 1679041321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144890427 NPI number — MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
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:
1144890427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936801
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31193-6801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-792-2311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 ROBERTS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29020-3737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-432-4311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RAE
Authorized Official First Name:
KARYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF, PAYOR RELATIONS
Authorized Official Telephone Number:
843-876-1344

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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