1417226028 NPI number — SOUTH CAROLINA INTERVENTIONISTS, INC.

Table of content: (NPI 1417226028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417226028 NPI number — SOUTH CAROLINA INTERVENTIONISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CAROLINA INTERVENTIONISTS, INC.
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:
1417226028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 AUBURN LN
Provider Second Line Business Mailing Address:
APARTMENT 19C
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29575-5159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-424-1129
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 AUBURN LN
Provider Second Line Business Practice Location Address:
APARTMENT 19C
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29575-5159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-424-1129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WARDELL
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-424-1129

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1073705 , 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)





Copyright © 2007-2025 www.npivalidator.com