1194829218 NPI number — BURNT CHURCH PRIMARY AND URGENT CARE, LLC

Table of content: (NPI 1194829218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194829218 NPI number — BURNT CHURCH PRIMARY AND URGENT CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURNT CHURCH PRIMARY AND URGENT CARE, 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:
6
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:
1194829218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 HOSPITAL CENTER BLVD
Provider Second Line Business Mailing Address:
ATTN ADMINISTRATION- KIM HOLSTEIN
Provider Business Mailing Address City Name:
HILTON HEAD ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29926-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-757-9229
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BURNT CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUFFTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29910-6405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-757-9229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
REGIONAL CFO, TENET
Authorized Official Telephone Number:
404-265-5009

Provider Taxonomy Codes

  • Taxonomy code: 207QA0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com