1174993729 NPI number — RACHEL MINK SPENCER OTR/L

Table of content: RACHEL MINK SPENCER OTR/L (NPI 1174993729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174993729 NPI number — RACHEL MINK SPENCER OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
RACHEL
Provider Middle Name:
MINK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINK
Provider Other First Name:
RACHEL
Provider Other Middle Name:
KLARA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174993729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2880 TRICOM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-9171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-797-5050
Provider Business Mailing Address Fax Number:
843-797-3633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 NEXTON SQUARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29486-7911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
854-429-4263
Provider Business Practice Location Address Fax Number:
843-767-8569
Provider Enumeration Date:
09/25/2015

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:  4594 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 4594 , 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: 7000950004 . This is a "ARCIS HEALTHCARE, LLC GROUP MEDICARE DME PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP6337 . This is a "ARCIS HEALTHCARE GROUP MEDICAID NO." identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P01555383 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: TH3009 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0119009759 . This is a "LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7000950005 . This is a "ARCIS HEALTHCARE, LLC GROUP MEDICARE DME PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: D043 . This is a "ARCIS HEALTHCARE GROUP MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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