1346645389 NPI number — MARIANNE M HAGOOD APRN

Table of content: MARIANNE M HAGOOD APRN (NPI 1346645389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346645389 NPI number — MARIANNE M HAGOOD APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGOOD
Provider First Name:
MARIANNE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

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:
1346645389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 RIBAUT RD
Provider Second Line Business Mailing Address:
BMAC CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
BEAUFORT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29902-5441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-522-5674
Provider Business Mailing Address Fax Number:
843-522-5678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BEAUFORT MEMORIAL EXPRESS CARE & OCCUPATIONAL HEALTH
Provider Second Line Business Practice Location Address:
974 RIBAUT ROAD
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29902-5486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-524-3344
Provider Business Practice Location Address Fax Number:
843-524-5574
Provider Enumeration Date:
11/04/2014

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: 363LF0000X , with the licence number:  0024172154 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 22013 , 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: 22013 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".