1396172599 NPI number — MISS SUZANNAH GLOVER COUNTRYMAN ED.S., LPES

Table of content: MISS SUZANNAH GLOVER COUNTRYMAN ED.S., LPES (NPI 1396172599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396172599 NPI number — MISS SUZANNAH GLOVER COUNTRYMAN ED.S., LPES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUNTRYMAN
Provider First Name:
SUZANNAH
Provider Middle Name:
GLOVER
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ED.S., LPES
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:
1396172599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 RIVERS AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-4650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-343-1012
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 RIVERS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-4650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-343-1012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2013

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: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TB0200X , with the licence number: 4662 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1588615918 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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